title: Cerebral Venous Air Embolism Secondary to Mesenteric Infarction.
abstract: Cerebral air embolism is a rare, yet potentially fatal condition. We present a case of retrograde cerebral venous air emboli arising from the hepatic portal venous system, secondary to a mesenteric infarction. A 69-year-old man with a history of gastrointestinal amyloidosis presented with fever and lethargy. Computed tomography of the brain detected multiple foci of air in the right frontal, fronto-parietal, and left lateral frontal sulci consistent with cerebral venous air emboli. Computed tomography of the abdomen and pelvis revealed moderate thickening and dilatation of the small bowel with diffuse scattered intestinal pneumatosis suggestive of mesenteric infarction with resultant extensive intrahepatic portal venous air. The patient was deemed a poor candidate for surgical intervention and died as a result of septic shock. We believe the cerebral venous air emboli was a result of retrograde flow of air arising from the hepatic venous air ascending via the inferior and superior vena cava to the cerebral venous system. To our knowledge, there have been no reported cases of retrograde cerebral venous air embolism arising from hepatic portal venous system secondary to mesenteric infarction. The clinical significance and prognosis in this setting requires further investigation.
authors.affiliation: University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Ittikorn
authors.initials: I
authors.lastname: Spanuchart
authors.affiliation: University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Aileen
authors.initials: A
authors.lastname: Tamura
authors.affiliation: University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Brent
authors.initials: B
authors.lastname: Matsuda
authors.affiliation: University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Qi Jie Nicholas
authors.initials: QJ
authors.lastname: Leo
authors.affiliation: University of Hawai'i Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
authors.forename: Hiro
authors.initials: H
authors.lastname: Sung
mesh_terms: D000368:Aged; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: cerebral venous embolism; intestinal pneumatosis and intrahepatic portal venous air; mesenteric infarction; septic shock