Air embolism in the internal jugular vein

A 52-year-old man with diffuse large B cell lymphoma was admitted to the intensive care unit with septic shock. He had been chronically ill with limited recovery following internal fixation for a pathologic left tibial fracture and had been residing in a long-term acute care hospital. A peripherally inserted central catheter was placed in the right upper extremity 1 month prior. The catheter was removed upon admission. While imaging the patient’s veins for vascular access, gas emboli were noted in the left internal jugular vein. These emboli are recognized as hyperechoic bubbles in the superior aspect of the vessel, with reverberation artifact extending deeper than the vessel (Fig. 1; Supplementary material 1). These emboli were present in the superior portion of the vein, extending above the angle of the jaw. At the time of imaging, the patient had been placed in the reverse Trendelenburg position, with slight right-side dependency. The right internal jugular vein had no evidence of air embolism. The patient experienced no adverse effects from the air embolism. It is suspected that these emboli inadvertently occurred through routine access of his catheter with intravenous flushes. Iatrogenic gas embolism is associated with increased mortality, and is typically treated with hyperbaric oxygen [1‐3].