Fatal air embolism to the right side of the heart during pneumonectomy for carcinoma. Result of broncho-azygous vein communication and positive-pressure ventilation.

A 59-year-old white man had an extensive bronchogenic carcinoma of the right upper lobe. During the course of pneumonectomy, the patient died unexpectedly. At autopsy, massive right-sided air embolism was evident, associated with broncho-azygous vein communication. The cause of the air embolism and subsequent death was almost certainly related to positive-pressure ventilation, allowing entry of air into the systemic venous system through the broncho-azygous vein communication. Because of the clinical implications of this problem, the case is reported, and suggestions for management are offered.