Role in the development of vascular catastrophes of the eye
The entry of air into the systemic circulation can lead to severe ischemic damage to various organs. One of the most prominent and critical complications of air embolism is acute occlusion of the central retinal artery (CRA), as well as its peripheral branches.
Embolization of retinal vessels by air bubbles requires emergency ophthalmological intervention. The main triggering factors that lead to the entry of air into the arterial bed of the eye include:
- Invasive diagnostic procedures.
- Closed and open chest injuries accompanied by the development of pneumothorax.
- Severe musculoskeletal injuries, in particular bone fractures (in these cases, air embolism is often considered alongside fat embolism).
Clinically, this condition manifests as a sharp drop in visual function, and accurate diagnosis is based on the characteristic ophthalmoscopic picture. The prognosis largely depends on the timing of emergency care.
Radiological signs in procedural complications
Air embolism can develop directly during medical manipulations, such as central venous catheterization or other endovascular procedures. In these cases, timely diagnostic imaging performed directly in the operating room plays a key role.
During fluoroscopy at the time of complication development, a specialist can visualize gas accumulation in the vascular bed. Specific markers confirming the diagnosis of air embolism on a radiograph include:
- Presence of air in the projection of the arch of the azygos vein.
- Presence of gas in the lumen of the pulmonary trunk.
These findings indicate the migration of the air bolus into the right heart chambers and the pulmonary artery system. Such complications require immediate cessation of the procedure and may become an indication for resuscitation measures.
Differential diagnosis with other types of embolisms
In the context of pulmonary vascular bed lesions, air embolism must be differentiated from other pathological conditions causing occlusion.
For example, the development of pulmonary arterial hypertension can be triggered not only by the entry of air, but also by tumor emboli (Tumour Emboli). Unlike gas bubbles, the blockage of small branches of the pulmonary artery by tumor cells is characteristic of metastatic cancer (hepatocellular carcinoma, breast, stomach, or kidney cancer). Another differential condition is septic embolism — the dissemination of infected thrombi (usually of staphylococcal etiology) into the lungs, which manifests on computed tomography as multiple cavitating nodules rather than gas accumulations in large vessels.
Class and exam questions
In which vessels can gas be seen during fluoroscopy in cases of air embolism?
During fluoroscopy, signs of air embolism are visualized as gas accumulations in the arch of the azygos vein and the pulmonary trunk.
What acute ophthalmological condition can air embolism lead to?
Air embolism can cause acute occlusion of the central retinal artery (CRA) or its branches.
What injuries and conditions predispose to the development of this complication?
The main risk factors include bone fractures, pneumothorax, and invasive diagnostic procedures.
What else to study on this topic
- Acute central retinal artery occlusion: ophthalmoscopic picture and management
- Complications during central venous catheter placement
- Fat embolism in bone fractures
- Tumor and septic embolism of pulmonary vessels
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