Cerebral air embolism during commercial air travel due to a giant pulmonary bulla

Abstract

Cerebral air embolism is a rare but potentially catastrophic complication of air travel in patients with pulmonary bullae or other air-containing intrathoracic lesions. A 59-year-old man lost consciousness approximately 20 min after take-off on a commercial flight. The aircraft immediately descended and returned to its departure airport, where he was transferred for emergency assessment. Computed tomography of the head demonstrated air bubbles in several intracranial cerebral arteries consistent with cerebral arterial air embolism, while thoracic imaging identified a giant right upper-lobe bulla. He recovered with mild persistent right-sided hemiparesis and subsequently underwent resection of the bulla. This case demonstrates how the reduction in cabin pressure during an otherwise routine flight may cause expansion of a pulmonary bulla, pulmonary barotrauma and entry of air into the systemic circulation. Cerebral air embolism should be considered when abrupt neurological symptoms occur during or shortly after aircraft ascent.