title: Cerebral air embolism after arthrography of the ankle.
abstract: BACKGROUND
  The accidental migration of air from the venous circulation into the systemic arterial circulation is called paradoxical air embolism. This is a potential disastrous complication after diagnostic and surgical procedures. Arthrography has been a useful technique in joint imaging for the past decades. Paradoxical cerebral air embolism is a very rare complication, only a few cases have been reported after arthrography of the hip in children. Here, we describe a patient with progressive encephalopathy after computer tomography (CT) arthrography of the ankle.
  
  
  METHODS
  We describe a 64-year-old male who underwent CT-arthrography of the left ankle, after the intra-articular injection of 20 ml of air he experienced progressive neurologic and hemodynamic deterioration. A brain CT showed a small amount of air in a right frontal sulcus. Hyperbaric oxygen therapy (HBO) was initiated after a delay of 16 hours and resulted in a complete recovery. A transesophageal echocardiography confirmed the presence of a right-left shunt.
  
  
  CONCLUSIONS
  This case of paradoxical air embolism with severe neurological manifestations after arthrography of the ankle, emphasizes that air embolism should be considered in all patients with neurologic and/or hemodynamic deterioration after the injection of intra articular air. Furthermore a delay of more then 6 hours is no reason to withhold HBO in these patients.
authors.affiliation: Department of Intensive Care, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. m.c.muller@amc.uva.nl
authors.forename: Marcella C A
authors.initials: MC
authors.lastname: Müller
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Menno R
authors.initials: MR
authors.lastname: Germans
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging*; D001175:Arthrography / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000009:adverse effects