title: Gas embolism caused by portal vein gas: case report and literature review.
abstract: BACKGROUND
  We describe a case of pulmonary gas embolism caused by portal vein gas (PVG) observed using echocardiography. Echography revealed gas flowing through the hepatic vein, inferior vena cava, right atrium, and right ventricle, as well as pulmonary hypertension. The patient was diagnosed as having pulmonary gas embolism caused by PVG.
  
  
  OBJECTIVE
  We consider PVG routes to pulmonary circulation, diagnosis of gas embolism caused by PVG, and treatment of gas embolism caused by PVG.
  
  
  METHODS
  We reviewed reports of eight cases of gas embolism caused by PVG and compared these cases to cases of gas embolism without PVG.
  
  
  RESULTS
  Mortality of gas embolism caused by PVG was 67%, positive blood culture was observed in six cases, and pulmonary edema was seen in three cases. PVG initially excites microbubble formation, which causes tissue damage in the liver and liver abscess. A large volume of PVG causes portal obstruction. As a result, portal hypertension, a portosystemic shunt or gastrointestinal congestion can occur. PVG can travel to the systemic vein through the liver or portosystemic shunt without anomaly and cause pulmonary gas embolism, followed by arterial embolism. In this environment, sepsis easily occurs. Echocardiography is useful for diagnosis of gas embolism caused by PVG, but the gas can be seen intermittently. The view of pulmonary edema is important for pulmonary gas embolism caused by PVG.
  
  
  CONCLUSIONS
  It is important to treat the underlying disease, but PVG must be considered and treated as the gas embolism's source.
authors.affiliation: Department of Surgery, Kagoshima Prefectural Sastunan Hospital, Minamisatuma City, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kamikado
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Nagano
authors.forename: Kouji
authors.initials: K
authors.lastname: Takumi
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Senokuchi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kubo
authors.forename: Shinji
authors.initials: S
authors.lastname: Mitsue
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Shouji
authors.initials: S
authors.lastname: Natugoe
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou