Air in the right ventricle and vein after basilar skull fracture: a case report
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(2020) 13:59
International Journal of Emergency Medicine
CASE REPORT
Open Access
Air in the right ventricle and vein after basilar skull fracture: a case report Hiroki Kai*, Tomoya Hirose , Takaya Nishiura, Takashi Noma, Yoshihito Ogawa, Tomoki Yamada, Haruhiko Nakae and Yasuaki Mizushima
Abstract Background: Air in the venous system may cause vascular air embolism, which is a potentially life-threatening event. The presence of air in venous system after basilar skull fracture is very rare. Case presentation: A 77-year-old man fell from a truck bed and suffered head and neck trauma. On hospital arrival, his consciousness was clear and his vital signs were stable. His chief complaint was pain in the back of his head and neck. Head CT showed traumatic subarachnoid hemorrhage in the right frontal area and basilar skull fracture of the occipital bone. Whole body CT showed pneumocephalus and air in the jugular vein and right ventricle. The patient was placed in the supine position in a state of absolute rest to prevent vascular air embolism and was treated conservatively. On hospital day 3, CT was reperformed, revealing disappearance of air in the right ventricle and decreased air in the veins of the head and neck. On hospital day 4, the air in the veins disappeared completely on CT. He did not experience vascular air embolism after increasing of his activity level (e.g., raising his head on hospital day 3 and standing and walking alone on day 5). He was discharged 34 days after admission without sequelae. Conclusions: Head trauma patients with basilar skull fracture might develop vascular air embolism if physicians fail to detect air in the venous system on hospital arrival. A high degree of suspicion regarding air in venous system or heart is required when patients present with such injuries. Keywords: Basilar skull fracture, Air embolism, Right ventricle, Jugular vein
Background Air in the venous system may result in vascular air embolism that can cause potentially life-threatening events. The occurrence of air in the venous system after basilar skull fracture, which may result in vascular air embolism, is rare [1–3]. To our knowledge, this is the first report of air in the right ventricle after basilar skull fracture in a non-fatal trauma case. Case presentation The patient was a 77-year-old man who fell from the loading platform of a truck (height 1.5 m) and landed on * Correspondence: [email protected] Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka-shi, Osaka 543-0035, Japan
the back of his head. He could initially walk without weakness or other symptoms. However, he gradually developed dyspnea and right hemiplegia and presented to the emergency department of another hospital. The physician found it difficult to diagnose and treat the patient, and he was immediately transferred to our emergency department by ambulance. On arrival, his consciousness was alert and his vital signs were stable. He felt occipital and posterior cervical pain. Th
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