Cerebral Air Embolism from Chronic Progressive Pulmonary Aspergillosis

A 66-year-old man had been treated for chronic progressive pulmonary aspergillosis (CPPA) with itraconazole (ITCZ) for 2 years. However, because a deterioration in the patient’s condition was observed in the imaging findings, the treatment was changed from ITCZ to voriconazole. A week later, he was transferred to our hospital due to an impaired consciousness and left hemiplegia. A computed tomography (CT) scan of the head showed the presence of multiple air emboli (Picture A). A chest CT scan demonstrated air in the intravascular space of the ascending aorta, pneumomediastinum, and a necrotic cystic lesion (Picture B). A head CT scan on hospital day 2 showed no air embolism, but the cerebral edema had rapidly worsened. Cerebral air embolism mainly occurs because of some invasive iatrogenic clinical problem. Although rare, there are some reports of cerebral air embolism due to intrathoracic diseases (1, 2). This patient underwent no invasive medical procedures during the clinical course. As a result, necrotic cystic lesions of CPPA were considered to have caused cerebral air embolism in this rare case.