Massive cerebral arterial air embolism

Case contributed by Arkadi Tadevosyan


Suddenly fell from the 8th floor while cleaning windows.

Patient Data

Age: 35 years
Gender: Female

On initial topogram

  • Right-sided tension pneumothorax (complete collapse of the right lung with a contralateral shift of mediastinal structures).
  • Left-sided pneumothorax (deep sulcus sign).

Post-placement of chest tube shows that tension has been relieved. 

  • bilateral pneumothorax mostly extensive on the left
  • multiple traumatic pneumatoceles bilaterally mostly extensive on the right
  • pneumomediastinum
  • multiple rib fractures
  • extensive ipsilateral subcutaneous emphysema
  • high-density material in the lower third of esophagus (probably fractured teeth fragments)
  • Massive air embolism of the intracranial arterial system. Circle of Willis including cortical branches, and also carotid and vertebral arteries are opacified by air, which was not visualized on the initial scan.
  • Extensive neck soft tissue emphysema.
  • Complex midfacial fractures bilaterally, associated with hemosinus.
  • Right mandibular parasymphyseal comminuted and bilateral displaced fractures of mandibular condyles( Guardsman fracture).
  • Multiple comminuted teeth fractures.

Case Discussion

There were also multiple fractures of lumbar vertebrae, pelvis and lower extremities (not shown). Unfortunately, the patient died two hours later.

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