Fatal air embolism to the right side of the heart during pneumonectomy for carcinoma. Result of broncho-azygous vein communication and positive-pressure ventilation.
A 59-year-old white man had an extensive bronchogenic carcinoma of the right upper lobe. During the course of pneumonectomy, the patient died unexpectedly. At autopsy, massive right-sided air embolism was evident, associated with broncho-azygous vein communication. The cause of the air embolism and subsequent death was almost certainly related to positive-pressure ventilation, allowing entry of air into the systemic venous system through the broncho-azygous vein communication. Because of the clinical implications of this problem, the case is reported, and suggestions for management are offered.
D001344:Autopsy; D001401:Azygos Vein; D001980:Bronchi / Q000473:pathology; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004618:Embolism, Air / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011859:Radiography