doi: 10.2169/internalmedicine.8606-16 Intern Med 56: 2241, 2017 http://internmed.jp

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Cerebral Air Embolism from Chronic Progressive Pulmonary Aspergillosis Hayato Yabe, Soichirou Watanabe, Atsushi Saito and Masami Yamazoe Key words: cerebral air embolism, aspergillosis

(Intern Med 56: 2241, 2017) (DOI: 10.2169/internalmedicine.8606-16)

A

A 66-year-old man had been treated for chronic progressive pulmonary aspergillosis (CPPA) with itraconazole (ITCZ) for 2 years. However, because a deterioration in the patient’s condition was observed in the imaging findings, the treatment was changed from ITCZ to voriconazole. A week later, he was transferred to our hospital due to an impaired consciousness and left hemiplegia. A computed tomography (CT) scan of the head showed the presence of multiple air emboli (Picture A). A chest CT scan demonstrated air in the intravascular space of the ascending aorta, pneumomediastinum, and a necrotic cystic lesion (Picture B). A head CT scan on hospital day 2 showed no air embolism, but the cerebral edema had rapidly worsened. Cerebral air embolism mainly occurs because of some invasive iatrogenic clinical problem. Although rare, there are some reports of cerebral air embolism due to intrathoracic diseases (1, 2). This patient underwent no invasive medical procedures during the clinical course. As a result, necrotic cystic lesions of CPPA were considered to have caused cerebral air embolism in this rare case.

B

The authors state that they have no Conflict of Interest (COI).

References 1. Otomune K, Yamamoto S, Kohara N. Cerebral air embolism associated with lung cancer. Intern Med 50: 2439, 2011. 2. Lin C, Barrio GA, Hurwitz LM, Kranz PG. Cerebral air embolism from angioinvasive cavitary aspergillosis. Case Rep Neurol Med 2014: 406106, 2014. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).

Picture

Department of Respiratory Medicine, Hakodate Municipal Hospital, Japan Received: November 27, 2016; Accepted: January 8, 2017; Advance Publication by J-STAGE: August 1, 2017 Correspondence to Dr. Hayato Yabe, [email protected] Ⓒ 2017 The Japanese Society of Internal Medicine. Intern Med 56: 2241, 2017

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Cerebral Air Embolism from Chronic Progressive Pulmonary Aspergillosis.

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