Cerebral arterial air embolism due to an esophago-atrial fistula seen on CT

A case of cerebral air embolism from a rather unusual cause is reported; an esophago-cardiac fistula permitted food particles and air to enter the systemic arterial circulation. Massive embolization caused the patient to become deeply comatose rather suddenly. The computed tomogram (CT) revealed massive cerebral edema with the contradictory finding of wide superficial subarachnoid spaces. These subarachnoid spaces on further evaluation proved to be air in the cerebral vessels.