Inactive tuberculosis cavity responsible for fatal cerebral air embolism

Excerpt

Sir: An 81-year-old man presented sudden coma which had occurred when he was at home. He had a past history of tuberculosis with left pleural reactivation. A few minutes before the abrupt loss of consciousness, he had experienced acute massive coughing with severe haemoptysis. Before admission to hospital the patient was intubated and mechanically ventilated as his Glasgow Coma Scale score was 3. A brain and chest computed tomography (CT) scan, performed ahead of admission to intensive care, revealed multiple air-isodense spots in both hemispheres of the brain suggesting cerebral air embolism (Fig. 1a) and a cavitation with a fluid–air level within chronic calcified left pleural empyema (Fig. 1b). Lung window analysis revealed visible bubbles in the left jugular and subclavian veins (not shown). Despite regular symptomatic care and hyperbaric oxygen therapy, the patient died 3 days after admission. Mycobacterium culture of multiple tracheal aspirations remained sterile.

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