Cerebrospinal air embolism following percutaneous nephrolithotomy: Gravitational gradient effect

摘要

Sir, Cerebral air embolism (CAE) as a complication of percutaneous nephrolithotomy (PCNL) has been observed in patients with or without intra-cardiac defects. Pyelovenous backflow may cause displacement of air from the renal pelvicalyceal system into the renal veins. The entry of gas emboli in arterial circulation is postulated to be via the pre-pulmonary arteriovenous arteriovenous (AV) shunts or directly through the pulmonary capillary bed. Onset of symptoms in such cases is likely to be delayed by some hours in view of time taken for passage of emboli through the pulmonary vasculature. We report a case of cerebral and spinal air embolism following percutaneous nephrolithotomy in a patient with no evidence of intra-cardiac defects or AV shunts.