Fatal cerebral air embolism associated with spontaneous bilateral pneumothorax in a patient with past history of pulmonary tuberculosis

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.