Air embolism in main pulmonary
D. 100% Oxygen, intravenous fluid, and Trendelenburg position
The fluoroscopy of the patient at the onset of dyspnea showed a pulsatile translucency in the main pulmonary artery (MPA). The shape of the opacity was similar to the trunk of the MPA and showed alternating expansion and contraction during the cardiac cycle. The opening and closing of the pulmonary valve were visible at the inferior part of the translucent shadow (Figure; Video). This was diagnosed as a large pulmonary artery air embolism in the MPA.
Pericardial effusion leading to pericardial tamponade is a rare complication of BMV. However, acute tamponade is accompanied by hypotension. Also, on fluoroscopy, tamponade will appear as a decreased movement of cardiac borders along with separation of visceral and parietal pericardium due to accumulation of blood, which was not present in this case. Hence, pericardiocentesis was not indicated. Acute massive pulmonary thromboembolism in the MPA gives rise to acute-onset hypotension and dyspnea, but fluoroscopy is usually unremarkable. Rarely, fluoroscopy may show a prominent pulmonary artery, an enlarged right descending pulmonary artery (Palla sign), an abrupt cutoff of vessels, elevated hemidiaphragm along with focal pulmonary oligemia (Westermark sign), and peripheral, pleural-based, wedge-shaped opacity (Hampton hump) due to pulmonary infarction. Acute pulmonary embolism appears as a filling defect on contrast angiography rather than on fluoroscopy. As none of these features was present, intravenous thrombolytic and catheter-directed embolectomy were not indicated in this patient.