{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:43:18Z","timestamp":1790739798932,"version":"4.1.0"},"reference-count":17,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,6,10]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Standard initial treatment for acute empyema involves antibiotic administration and chest tube drainage; however, pleural lavage with saline is another treatment that mitigates the need for surgical drainage. Although this treatment is recognised as non-invasive and safe, the complications of cerebral air embolism are less recognised.<\/jats:p>\n               <jats:p>In this case, a man in his late 40s was diagnosed with acute empyema and treated with chest tube (28 Fr) drainage and antibiotics. Empyema remained on follow-up chest imaging; thus intrapleural fibrinolytic therapy (urokinase 120\u2009000 units\/day for a total of 3\u2009days) and pleural lavage (0.9% saline 1000 mL\/day daily) were administered. During the 10th pleural lavage, the patient suddenly became unconscious. Head imaging revealed a cerebral air embolism. Consequently, he received urgent hyperbaric oxygen therapy and improved without any neurological sequelae.<\/jats:p>\n               <jats:p>Clinicians should be aware of the complications of sudden cerebral air embolism due to pleural lavage for empyema.<\/jats:p>","DOI":"10.1136\/bcr-2022-249618","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T13:31:26Z","timestamp":1656336686000},"page":"e249618","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Complications of cerebral air embolism associated with pleural lavage for empyema"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3795-2561","authenticated-orcid":false,"given":"Toru","family":"Ishihara","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Manabe","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Ozawa","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"key":"2025082703540565000_15.6.e249618.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"2025082703540565000_15.6.e249618.2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-3071"},{"key":"2025082703540565000_15.6.e249618.3","first-page":"CD002312","article-title":"Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema","volume":"2019","author":"Altmann","year":"2019","journal-title":"Cochrane Database Syst 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Shinkeigaku"},{"key":"2025082703540565000_15.6.e249618.12","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivt129"},{"key":"2025082703540565000_15.6.e249618.13","first-page":"237","article-title":"Cerebral air embolism after pleural streptokinase instillation","volume":"43","author":"Janisch","year":"2013","journal-title":"Diving Hyperb Med"},{"key":"2025082703540565000_15.6.e249618.14","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s11748-016-0737-x","article-title":"Systemic air embolism during pleural lavage for empyema","volume":"65","author":"Ohuchi","year":"2017","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2025082703540565000_15.6.e249618.15","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1016\/j.athoracsur.2020.02.068","article-title":"Cerebral air embolism after pleural lavage for empyema","volume":"110","author":"Capron","year":"2020","journal-title":"Ann Thorac 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