Embolie gazeuse cérébrale compliquant une pleurodèse au talc : à propos d’un cas

Cerebral air embolism is a severe complication which can occur during many invasive medical procedures. Its prognosis depends on early diagnosis and hyperbaric oxygen therapy. We report a case of cerebral air embolism which occurred during a talc pleurodesis within a chest tube, in chest postoperative period. After early and appropriate treatment, we observed a significant functional recovery.     

Embolies coronaires secondaires à un thrombus adhérent de l’oreillette droite par un foramen ovale perméable

This observation relates to the discovery of native coronary paradoxical embolism secondary to thrombus adherent to the right atrium through a patent foramen ovale (PFO). A patient of 64 years, with a history of mitral regurgitation not followed, was hospitalized for acute respiratory distress due to a mitral insufficiency (MI) with a ruptured chordae and pulmonary embolism. Coronary angiography was performed and revealed two typical images of coronary embolism associated to a non-atheromatous coronary tree. The patient underwent a mitral valve replacement. After the establishment of cardiopulmonary bypass, adherent fibrin and cruoric thrombus of the right atrium and a PFO were found. The analysis of the valves did not reveal any arguments for infective endocarditis. A CT scan, performed as the patient remained unconscious after surgery, showed several cerebral infarcts. Paradoxical embolism coronary was diagnosed in front of the combination of adherent thrombus in the right atrium, pulmonary embolism and systemic coronary and cerebral embolism with a PFO. Coronary embolism rarely happens. It is mainly due to three causes: iatrogenic origin in most cases, direct causes due to micro emboli, particularly from infectious endocarditis and paradoxical embolic origin. There are two types of right atrial thrombus; the most common is the mobile thrombus from the peripheral venous system. The other one, which is more rare, is the adherent thrombus, which occurs in situ. Coronary embolism of paradoxical origin represents a small proportion of the causes of coronary embolism. However, this diagnosis must be considered.     

114. Begleitende Gefäßverletzungen bei Frakturen und Luxationen der Extremitäten

Zusammenfassung Von 1969–1981 haben wir 329 Patienten mit insgesamt 369 arteriellen Embolien operiert, in 41 % innerhalb der 6 h-Grenze. Die Verteilung war wie folgt: Bein 71 %, Arm 21 %, Aortenbifurkation 6 % und A. mes. sup. 2 %. In 74 % erreichten wir eine Restitutio ad integrum, in 16 % den Gliedmaßenerhalt und in 10 % eine Amputation. 25 % starben: meist wegen Herzinsuffizienz, Apoplex oder Mesenterialinfarkt. Seit 1970 beträgt die weltweite Amputationsrate (19 Autoren, 2854 Embolektomien) 13 ± 6 %, die frühe postoperative Letalität 22 ± 8 %.     

Pulmonary embolism mimicking acute anterior myocardial infarction: diagnostic trap

Pulmonary embolism remains the major malingerer of acute chest disease. The clinical and electrocardiographic manifestations may deviate to a diagnosis of myocardial infarction. We report a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism. Coronary angiography performed after the second hospitalization was normal.     

Gas embolism: another story related to a central venous catheter withdraw

Paradoxical gas embolism is rare but life threatening complication of central venous access. In this observation, we report a paradoxical gas embolism accompanied by an acute respiratory failure and a coma following a jugular central venous access withdrawal in a liver transplanted patient. Following this observation, we discuss the prevention of gas embolism accidents and the hyperbaric oxygen therapy for its management.