Fatal Arterial Gas Embolism in an Adult 1 Year After Bilateral Sequential Lung Transplantation

Fatal systemic air embolism (SAE) related to positive pressure ventilation is a rare complication. Case reports in the pediatric literature usually relate to complications in ventilating neonates and are more common. We describe what we believe to be the first such case in an adult ventilated with a high-frequency oscillating ventilator (HFOV) for acute respiratory distress syndrome (ARDS). The patient had undergone bilateral sequential lung transplantation 12 months earlier for idiopathic pulmonary fibrosis. Radiographic findings showed cerebral and aortic gas embolization and livedo reticularis with widespread cerebral infarction and cerebral edema.