Moshe Heching MD, Shimon Izhakian MD, Orly Efros MD, Maor Mermelstein MD, Avigail Rockland BS, Moshe Shai Amor MD, Lev Freidkin MD, Dror Rosengarten MD, Dorit Shitenberg MD, Yael Shostak MD, Osnat Shtraichman MD, Mordechai Reuven Kramer MD
Cerebral arterial air embolism (CAAE) is a rare, but often fatal, complication of interventional bronchoscopy. Despite its rarity, a high index of suspicion can facilitate early diagnosis and prompt treatment. Standard of care treatment for CAAE is hyperbaric oxygen therapy, despite limited definitive data supporting its efficacy, given the conceptual potential for reversibility of neurological impairment. We describe five cases from our institution, and review the clinical presentation, pathophysiology, diagnosis, and management of suspected CAAE. Based on published case reports involving transbronchial lung biopsies (TBLB), standard of care treatment for CAAE secondary to TBLB is hyperbaric oxygen therapy, although its efficacy in this context has not been unambiguously validated in clinical practice.