Abstract:
Introduction: Post-tuberculous extensive pulmonary fibrosis is among most frequent causes
of spontaneous pneumothorax (SP). Simultaneous bilateral SP is an infrequent clinical condition,
less than one hundred cases have been described. Occurrence of air embolism is a rare complication
of SP, embolism of cerebral vessels being very uncommon. Pathogenesis of cerebral embolism
associated with spontaneous pneumothorax is uncertain.
Clinical case: We describe a fatal case of cerebral air embolism in a 43 years old man known
with two prior episodes of cured pulmonary tuberculosis. He was admitted to our clinic for
progressive dyspnea, during the last 7 days, and left chest pain. At physical exam he was
hypotensive with normal heart rate. Subcutaneous emphysema of chest and neck was observed. His
chest X ray revealed significant pulmonary fibrosis, secondary to prior pulmonary tuberculosis,
bilateral pneumothorax (more expressed on left) and subcutaneous emphysema. Insertion of left
chest drain tube was performed. Next day, during manipulation on drain tube, a sudden worsening
of patient condition, with a fatal outcome, occurred. At necropsy air pulmonary and cerebral
embolism was described. No heart structural abnormalities were found.
Conclusion: Cerebral air embolism is a rare complication of spontaneous pneumothorax, but
with a fatal risk. Further analysis of the reported cases could improve the understanding of the
mechanism of this clinical condition.
Description:
Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy "NicolaeTestemitanu", Chisinau, Republic of Moldova