Department of Radiology, University of Inha College of Medicine, 27 Inhang-ro, Jung-gu, Incheon, Korea.
Medicine (Baltimore). 2021 Dec 30;100(52):e28389. doi: 10.1097/MD.0000000000028389.
Cerebral air embolism from portal venous gas rarely occurs due to invasive procedures (e.g., endoscopic procedures, liver biopsy, or percutaneous transhepatic biliary drainage) that disrupt the gastrointestinal or hepatobiliary structures. Here, we report a rare case of fatal cerebral air embolism following a series of percutaneous transhepatic biliary drainage tube insertions.
A 50-year-old woman with a history of cholecystectomy, liver wedge resection, and hepaticojejunostomy for gallbladder cancer presented with altered mental status 1 week after percutaneous transhepatic biliary drainage tube placement.
Extensive cerebral air embolism and acute cerebral infarction.
Brain computed tomography and magnetic resonance imaging, hyperbaric oxygen therapy, medical therapy.
Despite the use of hyperbaric oxygen therapy and medical treatment including vasopressors, the patient eventually died due to massive systemic air embolism.
To date, there have been no reports of cerebral air embolism due to percutaneous transhepatic biliary drainage with pronounced radiologic images. We reviewed previously reported fatal cases associated with endoscopic hepatobiliary procedures and assessed the possible mechanisms and potential causes of air embolism.
由于胃肠或肝胆结构受到破坏的侵袭性操作（如内镜检查、肝活检或经皮经肝胆管引流），很少发生门静脉气体导致的脑空气栓塞。在此，我们报告了一例罕见的经皮经肝胆管引流管插入后发生致命性脑空气栓塞的病例。
一名 50 岁女性，因胆囊癌行胆囊切除术、肝楔形切除术和胆肠吻合术，在经皮经肝胆管引流管放置 1 周后出现精神状态改变。
广泛脑空气栓塞和急性脑梗死。
脑部计算机断层扫描和磁共振成像、高压氧治疗、药物治疗。
尽管使用了高压氧治疗和包括升压药在内的药物治疗，患者最终还是因全身空气栓塞而死亡。
迄今为止，尚无经皮经肝胆管引流引起的伴有明显影像学表现的脑空气栓塞报道。我们回顾了以前报道的与内镜肝胆手术相关的致命病例，并评估了空气栓塞的可能机制和潜在原因。
