Case of 78-Year-Old Male with Cerebral Gas Embolism Associated with Combined Pulmonary Fibrosis and Emphysema.

Cerebral gas embolism (CGE) from the thoracic cavity is commonly associated with invasive procedures, and cases of spontaneous CGE are rare. A 78-year-old man presented with severe spontaneous CGE associated with combined pulmonary fibrosis and emphysema (CPFE). To the best of our knowledge, the comorbidity of CGE in a CPFE patient has not been documented until now. The patient became unconscious with left hemiparesis at approximately 2 a.m. Computed tomography scan revealed minute air densities scattered in the deep white matter of the right frontal lobe. The patient died on the sixth day of hospitalization. We postulated that CGE can be classified as either arterial CGE or retrogradely infused venous CGE. To differentiate between these two, the distribution of air densities provided useful information in our case. We assumed that the air was infused through the pulmonary vein to the left atrium of the heart, resulting in arterial CGE. A review of the literature further suggests that an upright position at the time of a CGE attack might be related to the retrogradely infused venous origin of the air, whereas arterial CGE may more likely occur when the patient is lying down.