{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T14:52:02Z","timestamp":1785941522093,"version":"3.56.0"},"reference-count":9,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wroclaw Medical University","award":["SUBZ.B180.24.058"],"award-info":[{"award-number":["SUBZ.B180.24.058"]}]},{"name":"Faculty of Veterinary Medicine, Wroc\u0142aw University of Environmental and Life Sciences","award":["SUBZ.B180.24.058"],"award-info":[{"award-number":["SUBZ.B180.24.058"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2\u20133% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient\u2019s hemodynamic status, adequate hydration and positioning during the procedure.<\/jats:p>","DOI":"10.3390\/diagnostics14131425","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T08:45:34Z","timestamp":1719996334000},"page":"1425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of Tomographic Images of a Catastrophic Gas Embolism during Endoscopic Retrograde Cholangiopancreatography"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6580-9954","authenticated-orcid":false,"given":"Marta","family":"Frydrych","sequence":"first","affiliation":[{"name":"Sokolowski Specialist Hospital in Walbrzych, Sokolowski, 58-309 Walbrzych, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4298-3178","authenticated-orcid":false,"given":"Marceli","family":"\u0141ukaszewski","sequence":"additional","affiliation":[{"name":"Sokolowski Specialist Hospital in Walbrzych, Sokolowski, 58-309 Walbrzych, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-0798","authenticated-orcid":false,"given":"Kamil","family":"Nelke","sequence":"additional","affiliation":[{"name":"Private Practice of Maxillo-Facial Surgery and Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wroc\u0142aw, Poland"},{"name":"Health Department, Academy of Applied Sciences Angelus Silesius in Wa\u0142brzych, Zamkowa 4, 58-300 Walbrzych, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4357-2271","authenticated-orcid":false,"given":"Maciej","family":"Janeczek","sequence":"additional","affiliation":[{"name":"Department of Biostructure and Animal Physiology, Wroc\u0142aw University of Environmental and Life Sciences, Ko\u017cuchowska 1, 51-631 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5187-5324","authenticated-orcid":false,"given":"Agata","family":"Ma\u0142yszek","sequence":"additional","affiliation":[{"name":"Department of Biostructure and Animal Physiology, Wroc\u0142aw University of Environmental and Life Sciences, Ko\u017cuchowska 1, 51-631 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Nienartowicz","sequence":"additional","affiliation":[{"name":"Private Practice of Maxillo-Facial Surgery, Romualda Mielczarskiego 1, 51-663 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-9028","authenticated-orcid":false,"given":"Grzegorz","family":"Gogolewski","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Wroc\u0142aw Medical University, Borowska 213, 50-556 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-1534","authenticated-orcid":false,"given":"Maciej","family":"Dobrzy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry and Preclinical Dentistry, Wroc\u0142aw Medical University, Krakowska 26, 50-425 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref_1","first-page":"156","article-title":"Gas embolism during endoscopic retrograde cholangiopancreatography: Diagnosis and management","volume":"32","author":"Lanke","year":"2019","journal-title":"Ann. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.14740\/gr1208","article-title":"Clinical Presentation, Diagnosis, and Management of Air Embolism During Endoscopic Retrograde Cholangiopancreatography","volume":"12","author":"Maqsood","year":"2019","journal-title":"Gastroenterol. Res."},{"key":"ref_3","first-page":"e31779","article-title":"Gas Pressure from the Endoscope: An Unexplored Contributor to Morbidity and Mortality?","volume":"14","author":"Wardhan","year":"2022","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e236135","DOI":"10.1136\/bcr-2020-236135","article-title":"Air embolism of right coronary artery after ERCP","volume":"13","author":"Dioscoridi","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104403","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104403","article-title":"Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment","volume":"28","author":"Ghannam","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1111\/j.1399-6576.2009.01947.x","article-title":"Venous air embolism induces both platelet dysfunction and thrombocytopenia","volume":"53","author":"Neumann","year":"2009","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"214","DOI":"10.4103\/1793-5482.150223","article-title":"Acute pulmonary edema and thrombocytopenia following venous air embolism during sitting position neurosurgery","volume":"12","author":"Saigal","year":"2017","journal-title":"Asian J. Neurosurg."},{"key":"ref_8","first-page":"51","article-title":"Procalcitonin and Liver Disease: A Literature Review","volume":"7","author":"Dong","year":"2019","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1097\/MEG.0b013e32833c5459","article-title":"Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography","volume":"22","author":"Finsterer","year":"2010","journal-title":"Eur. J. Gastroenterol. Hepatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1425\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:09:36Z","timestamp":1760108976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,3]]},"references-count":9,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["diagnostics14131425"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14131425","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,3]]}}}