Alali Jawdat M, Amara Umm E, Nashrah Umm E, Ummunnisa Firdous E, Tabouni Mahmoud, Shaikh Nissar M
Surgical Intensive Care Unit, Hamad Medical Corporation (HMC), Doha, Qatar.
Deccan College of Medical Sciences, Hyderabad, India.
Int J Surg Case Rep. 2025 Aug 18;135:111836. doi: 10.1016/j.ijscr.2025.111836.
Vascular air embolism (VAE) is a rare but potentially life-threatening complication, especially during neurosurgical procedures in the sitting position. While intraoperative VAE is well-documented, its progression to systemic inflammatory response syndrome (SIRS), massive pleural effusion, and acute respiratory distress syndrome (ARDS) is exceedingly rare.
A 32-year-old woman undergoing cerebellopontine angle schwannoma excision developed intraoperative VAE. Despite successful initial management, she progressed to SIRS, bilateral pleural effusions, and ARDS. She required invasive ventilation, bilateral pleural drainage, vasopressor support, and advanced hemodynamic monitoring with PiCCO. Gradual improvement was observed with supportive care, and she was successfully extubated and discharged.
This case illustrates how micro air emboli can trigger severe inflammatory and pulmonary responses, mimicking sepsis and cardiac failure. Capillary leak and pulmonary endothelial injury are key mechanisms.
VAE can lead to serious complications including ARDS and SIRS. Early recognition and aggressive supportive management are essential for recovery.
血管空气栓塞（VAE）是一种罕见但可能危及生命的并发症，尤其是在坐位神经外科手术期间。虽然术中VAE已有充分记录，但其进展为全身炎症反应综合征（SIRS）、大量胸腔积液和急性呼吸窘迫综合征（ARDS）极为罕见。
一名32岁女性在进行桥小脑角神经鞘瘤切除术中发生了术中VAE。尽管初始处理成功，但她仍进展为SIRS、双侧胸腔积液和ARDS。她需要有创通气、双侧胸腔引流、血管活性药物支持以及使用脉波指示剂连续心输出量（PiCCO）进行高级血流动力学监测。通过支持治疗观察到病情逐渐改善，她成功脱机并出院。
本病例说明了微小空气栓子如何引发严重的炎症和肺部反应，类似于脓毒症和心力衰竭。毛细血管渗漏和肺内皮损伤是关键机制。
VAE可导致包括ARDS和SIRS在内的严重并发症。早期识别和积极的支持性管理对康复至关重要。
