Air embolism involving the coronary and pulmonary circulation: an unusual cause of sudden cardiac death.

A 58-year-old man with a history of cirrhosis and hepatocellular carcinoma status post liver and kidney transplantation, coronary artery disease, and ventricular arrhythmia status post ICD placement underwent an outpatient fine-needle aspiration biopsy of a pulmonary nodule under computed tomography (CT) guidance at an outside hospital (Figure 1). After the procedure, the patient was noted to have persistent altered mental status that was out of proportion to the degree of sedation administered. He subsequently had a cardiopulmonary arrest secondary to ventricular tachycardia and needed prolonged cardiopulmonary resuscitation prior to return of spontaneous circulation. He underwent a CT scan of the head that revealed evidence of massive cerebral air embolism (Figure 2). A CT of the chest revealed evidence of extensive air within the leftand right-sided chambers of the heart including the right ventricle, pulmonary artery, and aorta, as well as