Air embolism is the entry of gas into vascular structures. It is a rare life-threatening complication of several medical procedures, in particular lung biopsy and central catheter insertion. The prevalence is 0.06%, but may be underestimated. It can have an asymptomatic course. Symptomatic air embolism can be accompanied by respiratory insufficiency and myocardial or cerebral infarction. We present a 78-year-old woman with acute hypotension and unconsciousness after lung biopsy. A CT scan showed air embolism in both the pulmonary and systemic circulation, followed by myocardial infarction and stroke. She was admitted to the intensive care unit for stabilisation and hyperbaric oxygen therapy. The patient improved, but a hemi-paralysis remained. Recognising air embolism is important to prevent further embolisation and to start treatment. Treatment is mostly supportive. In severe cases, 100% oxygen is supplied to expel air, thereby limiting permanent injury. In case of neurological and cardiac complications, hyperbaric oxygen is indicated.
Meigs syndrome is a rare clinical entity of benign origin in which a triad of ovarian tumour (usually ovarian fibroma or fibroid-like tumour), hydrothorax and ascites co-exist and raise suspicion of malignancy. Here, we report the case of a 60-year-old female presenting with a suspicion of ovarian cancer with pleural fluid and ascites, although eventually found to be of benign origin and curated after resection of the tumour. By presenting the case, we emphasise the importance of meticulously evaluating the diffierential diagnosis in patients with suspected advanced cancer in the absence of pathological confirmation. Moreover, we raise awareness for the complexity of evaluating which patient categories could benefit from intensive care treatment. In this specific case, with the absence of a pathological diagnosis, the option of benign cause is important to consider, even when possible malignancy interacts with a patient's wishes for treatment.
A 72-year-old patient was admitted to the intensive care unit with respiratory failure due to rapidly progressive interstitial lung disease (ILD). All cultures and PCRs focused on ILD were negative and a paraneoplastic phenomenon was deemed unlikely after screening for malignancy. Inflammatory myositis was suspected as the patient also presented fever, progressive pitting oedema and arthritis in both hands and feet. A myositis blot revealed high titres of anti- Jo-1 antibodies: the patient was diagnosed with antisynthetase syndrome and was treated with high-dose corticosteroids, cyclophosphamide and intravenous immunoglobulins with a gradual full recovery. Antisynthetase syndrome should be considered in patients with idiopathic or rapidly progressive ILD.
