Case reportMultimodal imaging approach to cerebral gas embolism lesions
Section snippets
Case report
An adult male with a history of left pulmonary squamous cell carcinoma began to show respiratory failure in relation to pleural effusion, which was subsequently treated by pleural puncture. However, 2 h after the procedure, the patient fell into a coma [Glasgow Coma Scale (GCS) score = 3] and was referred to the intensive care unit.
A cerebral computed tomography (CT) scan (Fig. 1) was immediately performed, and revealed disseminated supratentorial cerebral gas bubbles (air-equivalent attenuation
Discussion
The present case report illustrates the importance of multimodal cerebral imaging for the diagnosis of cerebral gas embolism and for greater comprehension of the pathophysiological mechanisms underlying cerebral injuries. CT and MRI may also be helpful for demonstrating the presence of gas bubbles in the cerebral parenchyma during the early phase of cerebral gas embolism.
The initial MRI session performed with the first few hours after the onset of symptoms revealed no parenchymal signal
Conclusion
Cerebral CT and MRI scans can help in the diagnosis of air embolism in the acute phase by demonstrating the presence of cerebral air bubbles. However, multimodal imaging analysis (conventional MRI, DTI, 1H-MRSI and FDG–PET) of secondary cerebral injury would help to achieve a greater understanding of the underlying mechanisms of lesions. Indeed, such imaging would be able to distinguish two types of lesions: toxic white-matter injury with myelin and neuronal abnormalities, and vasogenic edema;
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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