Cerebral air embolism after indwelling pleural catheter insertion in a chronic hydropneumothorax secondary to epithelioid mesothelioma

A 75-year-old man with a history of epithelioid mesothelioma and a right-sided indwelling pleural catheter (IPC) presented with a history of a purulent fluid drainage via the IPC. The pleural fluid cultured Klebsiella oxytoca and Enterococcus faecalis. He was treated with a course of oral fluoroquinolone followed by uneventful IPC replacement. One and half hours postprocedure, the patient had a witnessed drop in conscious level accompanied by seizure like activity. Acute stroke was suspected and a CT head was performed. CT head revealed multiple serpiginous pockets of air along the cerebral fissure, with features that were highly suggestive of cerebral air embolism and multiple wedge-shaped areas of infarction involving the cerebral hemispheres. Further imaging revealed satisfactory position of the replaced IPC. The patient was admitted to the intensive care unit for high flow oxygen therapy and head down ventilation. However, his condition deteriorated and he died later.

Pulling out a broken catheter using interventional radiology in a preterm. Neonatal intensive care

There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.

Standard pleural interventions are not high-risk aerosol generating procedures.

No evidence exists regarding the risk of aerosolisation from pleural procedures. This study used two discrete methodologies, in an environment with no background aerosol interference, to measure aerosol generation from 10 different pleural procedures (3 medical thoracoscopies, 3 indwelling pleural catheter insertions, 1 therapeutic thoracentesis, and 3 indwelling pleural catheter removals). The measurements indicated that, any aerosol production during these procedures was significantly lower than aerosols produced by the patient breathing or coughing. Pleural procedures should not be considered aerosol generating. We hope this study informs future iterations of guidelines on the appropriate use of PPE when performing these procedures.