Anisau, Aliaksandr

Vanhoenacker, Filip

Journal of the Belgian Society of Radiology

Ghent University Academic Bibliography

Case StudyA 90-year-old woman underwent computed tomogra-phy (CT) of the skull because of head trauma. Approxi-mately 30 minutes preceding the CT, she received a peripheral intravenous infusion with physiological fluid and paracetamol. CT excluded intracranial bleed-ing, but multiple small intracranial air bubbles were present at the cavernous (Figures 1 and 3) and inter-cavernous venous sinus (Figures 1 and 2) at the skull base. Although the presence of air bubbles raised sus-picion of a skull base fracture, no fracture could be demonstrated and the paranasal sinuses were normally pneumatized.IMAGES IN CLINICAL RADIOLOGYIntravascular Pneumocephalus: A Mimicker of Skull Base FracturesAliaksandr Anisau* and Filip Vanhoenacker†Keywords: retrograde venous embolism; air embolism; pneumocephalus; sinus cavernosusAnisau, A and Vanhoenacker, F. Intravascular Pneumocephalus: A Mimicker of Skull Base Fractures. Journal of the Belgian Society of Radiology. 2019; 103(1): 29, 1–2. DOI: https://doi.org/10.5334/jbsr.1795* AZ Sint-Maarten Mechelen, University of Ghent, BE† AZ Sint-Maarten and University (Hospital)  Antwerp/Ghent, BECorresponding author: Prof. dr. Filip Vanhoenacker  (filip.vanhoenacker@telenet.be)Figure 1: CT of the skull, bone window, axial reformat-ted image. Air bubbles at sinus cavernosus (white arrow) and sinus intercavernosus (white arrowhead).Figure 2: CT of the skull, bone window, axial  reformatted image. Air bubbles at sinus intercavernosus (white arrowheads).Figure 3: CT of the skull, bone window, coronal refor-matted image. Air bubbles at sinus cavernosus (white arrow). Normal pneumatisation of the sphenoid sinuses and absence of a fracture.Anisau and Vanhoenacker: Intravascular PneumocephalusArt. 29, page 2 of 2 CommentIntravascular pneumocephalus, namely an air embolism into the intracranial vascular system, may be a complication of an intravenous catheterization. It is regarded an uncom-mon finding, although a prospective study by Thompson et al. exposed six cases out of 100 CT scans in patients with intravenous catheters. Two potential pathophysi-ologic mechanisms have been described. The air bubbles may spread through a pre-existing anatomical right-left shunt (such as a congenital septum defect or a pulmonary arteriovenous malformation), also known as paradoxal air embolism [1]. Secondly, the air bubbles follow a direct path in the cephalad direction, designated retrograde air embo-lism [1]. In the latter scenario, the air bubbles get trapped most often in the cavernous sinus. They may also spread to other dural sinuses or in cortical cerebral veins. An upright or semi-seated position of the patient, Valsalva and valve insufficiency of the jugular veins are important contribut-ing factors promoting retrograde venous embolism [1].An intracranial venous air embolism may be either symptomatic or asymptomatic, depending on locali zation and extent of the embolism. In symptomatic cases, typical manifestations are mental state alterations, seizures, loss of consciousness, focal neurological defi-cits, cerebral edema, and eventually death [1]. Cerebral venous infarctions due to gas embolism has also been reported.Symptomatic cerebral air embolism can be treated by hyperbaric oxygen, no other measures have been proven effective in management of venous air embolism. Avoidance of iatrogenic retrograde cerebral venous embo-lism is important [1].Competing InterestsThe authors have no competing interests to declare.Reference 1. Won, SSM, Hau, CK and Todd, SI. Venous air  embolism related to the use of central catheters revisited: With emphasis on dialysis catheters. Clinical Kidney Journal. 2017; 10(6): 797–803. DOI: https://doi.org/10.1093/ckj/sfx064How to cite this article: Anisau, A and Vanhoenacker, F. Intravascular Pneumocephalus: A Mimicker of Skull Base Fractures. Journal of the Belgian Society of Radiology. 2019; 103(1): 29, 1–2. DOI: https://doi.org/10.5334/jbsr.1795Submitted: 14 March 2019        Accepted: 21 April 2019        Published: 09 May 2019Copyright: © 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.                           OPEN ACCESS Journal of the Belgian Society of Radiology is a peer-reviewed open access journal published by Ubiquity Press.

Intravascular pneumocephalus : a mimicker of skull base fractures

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Intravascular Pneumocephalus: A Mimicker of Skull Base Fractures

Institutional Repository Universiteit Antwerpen

https://lirias.kuleuven.be/handle/20.500.12942/707733

Intravascular pneumocephalus : a mimicker of skull base fractures

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Ghent University Academic Bibliography

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Institutional Repository Universiteit Antwerpen