Necrotizing Pneumonia and Cerebral Air Embolism

Excerpt

A 28-year-old man experienced acute respiratory failure due to PVL-positive Staphylococcus aureus pneumonia. Chest computed tomography (CT) showed multiple cavernous lesions indicating necrotizing pneumonia (Fig. 1a). The patient received mechanical ventilation and was treated with antibiotic therapy. After initial recovery, he suffered another respiratory failure due to aspiration during vomiting. His cardiopulmonary condition deteriorated rapidly, resulting in unconsciousness and additionally detected conjugate eye deviation. Emergency chest CT confirmed aspiration pneumonia, whereas brain CT revealed generalized bihemispheric cerebral air embolism (Fig. 1b), and a follow-up magnetic resonance imaging scan revealed cortical diffusion restriction (Fig. 1c). The air embolism likely occurred because of a right-to-left shunt from a necrotic lung lesion during his cardiopulmonary depressed state. No patent foramen ovale was found, but a positive bubble test result suggested an underlying pulmonary venous shunt. Following an extended stay in the intensive care unit, the patient was discharged to rehabilitation, with improving sensorimotor function but persistent visual deficits and neuropsychological limitations.

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