Coronary artery air embolism is a rare complication in the non–operating room anesthesia environment. In this setting, coronary artery air embolism is generally caused by communication between the atmosphere and the pulmonary venous system or by the creation of a bronchial-venous or alveolar-venous fistula during lung biopsy. Typical presentation is a result of the ensuing myocardial ischemia, and includes chest pain, arrhythmia, ST segment changes, bradycardia, hypotension, and cardiovascular collapse.Figure 1 represents the intraprocedural computed tomography imaging of a 74-yr-old woman who underwent percutaneous lung biopsy. Clearly visible is the air-fluid level in the ascending aorta, just distal to the right coronary artery ostia. Figure 2 shows air in the proximal right coronary artery. This patient’s procedural course was complicated by profound bradycardia, arrhythmia, and cardiogenic shock secondary to acute myocardial ischemia.

Risk of coronary artery air embolism is underappreciated outside the cardiac operating room; thus, the...

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