A rare case: cerebral air embolism causing stroke after lung cancer ablation

Abstract

Copyright © 2024 The Author(s). This is an Open Access article published by MA Healthcare Ltd and distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: CC BY-NC 4.0 A 75-year-old male patient was consulted because of a sudden onset of decreased consciousness immediately after radiofrequency ablation (RFA) of lung cancer. Non-contrast axial computed tomography (CT) showed air densities along the vascular trace in the frontoparietal sulci of both cerebral hemispheres, more prominent on the right (Figure 1A, white arrows). Minimum intensity projection (MinIP) reformation from CT showed air images probably of arterial origin more clearly (Figure 1B, white arrowheads). Diffusion-weighted imaging showed restricted diffusion in cortical and subcortical areas and centrum semiovale in both cerebral hemispheres, more markedly on the right, consistent with watershed infarction (Figure 1C, D). The patient was diagnosed as acute watersheed infarction secondary to cerebral arterial air embolism. Treatment was started immediately but unfortunately the patient died.

Figure 1. Imaging findings of a 75-year-old male patient with sudden onset of decreased consciousness. A. Non-contrast CT scan showed air densities along the vascular trace in the frontoparietal sulci of both cerebral hemispheres (white arrows). B. Minimum intensity projection reformation from CT showed air images probably of arterial origin more clearly (white arrowheads). C and D. Diffusion-weighted imaging showed restricted diffusion in bilateral cerebral hemispheres consistent with watershed infarction.