title: Air tract in the thrombus: paradoxical cerebral air embolism through a residual catheter track.
abstract: We report a 49-year-old woman who sustained ischemic stroke after central venous catheter removal. Brain computed tomography (CT) scan revealed air bubbles in the subarachnoid vessels. Contrast-enhanced chest CT and ultrasonography revealed a residual catheter track in the center of a jugular vein thrombus. A right-to-left shunt was confirmed by transthoracic echocardiography and transcranial Doppler with bubble contrast. The patient was ultimately diagnosed with a paradoxical cerebral air embolism through the residual catheter track in the thrombus. Rapid recognition, response, and prompt diagnosis are the most important factors in the successful treatment of such an embolism.
authors.affiliation: Stroke Center and Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan. oyama@medone.med.osaka-u.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Oyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D002545:Brain Ischemia / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002533:Cerebral Angiography / Q000379:methods; D020878:Device Removal; D038524:Diffusion Magnetic Resonance Imaging; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D020521:Stroke / Q000209:etiology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000209:etiology*