증례 : 중심정맥 카테터 제거후 발생한 기이성 공기 색전증 1 예

Paradoxical air embolism (PAE) can be a devastating complication which may occur in patients at risk for venous air embolism. With improved diagnostic techniques, such as echocardiography, PAE is being identified more frequently as a possible etiology in ischemic strok. A 80-year-old woman was admitted to intensive care unit with severe dyspnea and purulent sputum. Immediate after admission dyspnea was worsen, then mechanical ventilator support begun and triple-lumen central venous catheter was placed in right subclavian vein for proper nutritional supply and easy to blood sampling. Echocardiography showed no abnormal finding. On the 36th hospital day, she could spontaneous respiration with 30% oxygen by T-Piece. After 3 days she was transferred to general ward. At the next day, central venous catheter was removed, but dressing was not placed over the wound and pressure was not exerted on the area while catheter tip was processd for bacterial culture. She became tachypneic, anxious, and comatous. The blood pressure was 160/100 mmHg; heart rate, 150/ min; respiration rate, 36/min; temperature, 36.℃. Electrocardiography revealed sinus tachycardia and righ axis deviation. Partial oxygen tension of arterial blood was 42 mmHg while breathing with 3 L/min oxygen flowing through a T-piece. Chest roentgenogram was unchanged from previous film. Computed tomography of the brain showed multiple small round air density in the frontal and occipital lobe, suggestive of cerebral embolism due to paradoxical air embolism. We thought that she had a catheter in place long enough for a fibrinous tract to form that could remain open after the removal of the catheter and lack of a dressing impermeable to air would allow air to be entrained through a tract during inspiration, then this air delivered to cerebral circulation via pulmonary arteriovenous fistula.