• Jae Ho Lee, Ha Young Lee, Myung Kwan Lim, and Young Hye Kang.
• Department of Radiology, University of Inha College of Medicine, 27 Inhang-ro, Jung-gu, Incheon, Korea.
• Medicine (Baltimore). 2021 Dec 30; 100 (52): e28389e28389.

RationaleCerebral air embolism from portal venous gas rarely occurs due to invasive procedures (e.g., endoscopic procedures, liver biopsy, or percutaneous transhepatic biliary drainage) that disrupt the gastrointestinal or hepatobiliary structures. Here, we report a rare case of fatal cerebral air embolism following a series of percutaneous transhepatic biliary drainage tube insertions.Patient ConcernsA 50-year-old woman with a history of cholecystectomy, liver wedge resection, and hepaticojejunostomy for gallbladder cancer presented with altered mental status 1 week after percutaneous transhepatic biliary drainage tube placement.DiagnosesExtensive cerebral air embolism and acute cerebral infarction.InterventionsBrain computed tomography and magnetic resonance imaging, hyperbaric oxygen therapy, medical therapy.OutcomesDespite the use of hyperbaric oxygen therapy and medical treatment including vasopressors, the patient eventually died due to massive systemic air embolism.LessonsTo date, there have been no reports of cerebral air embolism due to percutaneous transhepatic biliary drainage with pronounced radiologic images. We reviewed previously reported fatal cases associated with endoscopic hepatobiliary procedures and assessed the possible mechanisms and potential causes of air embolism.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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