Spanuchart Ittikorn, Tamura Aileen, Matsuda Brent, Leo Qi Jie Nicholas, Sung Hiro
University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
Hawaii J Med Public Health. 2016 May;75(5):133-6.
Cerebral air embolism is a rare, yet potentially fatal condition. We present a case of retrograde cerebral venous air emboli arising from the hepatic portal venous system, secondary to a mesenteric infarction. A 69-year-old man with a history of gastrointestinal amyloidosis presented with fever and lethargy. Computed tomography of the brain detected multiple foci of air in the right frontal, fronto-parietal, and left lateral frontal sulci consistent with cerebral venous air emboli. Computed tomography of the abdomen and pelvis revealed moderate thickening and dilatation of the small bowel with diffuse scattered intestinal pneumatosis suggestive of mesenteric infarction with resultant extensive intrahepatic portal venous air. The patient was deemed a poor candidate for surgical intervention and died as a result of septic shock. We believe the cerebral venous air emboli was a result of retrograde flow of air arising from the hepatic venous air ascending via the inferior and superior vena cava to the cerebral venous system. To our knowledge, there have been no reported cases of retrograde cerebral venous air embolism arising from hepatic portal venous system secondary to mesenteric infarction. The clinical significance and prognosis in this setting requires further investigation.
脑空气栓塞是一种罕见但可能致命的疾病。我们报告一例继发于肠系膜梗死的肝门静脉系统逆行性脑静脉空气栓塞病例。一名有胃肠道淀粉样变性病史的69岁男性出现发热和嗜睡症状。脑部计算机断层扫描在右侧额叶、额顶叶和左侧额叶外侧脑沟发现多个空气灶，符合脑静脉空气栓塞表现。腹部和骨盆计算机断层扫描显示小肠中度增厚和扩张，伴有弥漫性散在的肠积气，提示肠系膜梗死并导致广泛的肝内门静脉积气。该患者被认为不适合手术干预，最终死于感染性休克。我们认为脑静脉空气栓塞是由于肝静脉空气经下腔静脉和上腔静脉逆行至脑静脉系统所致。据我们所知，此前尚无继发于肠系膜梗死的肝门静脉系统逆行性脑静脉空气栓塞的病例报道。这种情况下的临床意义和预后需要进一步研究。
