Electrocardiogram and X-ray findings associated with iatrogenic pulmonary venous gas embolism

Iatrogenic venous gas embolism (VGE) has been described in cases of patients with hemodialysis catheters and other thoracic central lines. When VGE is present, it may lead to large gas bubbles in the right heart or pulmonary circulation. We reviewed a case of a 52-year-old male hemodialysis patient who inadvertently received an unknown amount of air through a faulty connection in his line during hemodialysis treatment. The patient was symptomatic with chest pain and was found to have an ECG indicative of acute right heart strain and an unusual bulging of his right mediastinum on X-ray. An emergency consult was called for hyperbaric oxygen therapy (HBO2T) due to the known indications for therapy. The patient had a full recovery after HBO2T and had complete relief of his chest pain after compression. Repeat decubitus chest X-ray and ECG post-HBO2T showed resolution of the mediastinal bulge, and ECG had reverted to the patient's baseline tracing. Iatrogenic pulmonary VGE may be diagnosed with the aid of ECG and X-ray findings when correlated with historical and other clinical elements. HBO2 treatment success may be correlated with reversal of ECG and X-ray findings in patients with clinical improvement.