From air embolism to acute respiratory distress syndrome: A rare complication in a posterior fossa tumour excision - A case report.

INTRODUCTION AND

IMPORTANCE

Vascular air embolism (VAE) is a rare but potentially life-threatening complication, especially during neurosurgical procedures in the sitting position. While intraoperative VAE is well-documented, its progression to systemic inflammatory response syndrome (SIRS), massive pleural effusion, and acute respiratory distress syndrome (ARDS) is exceedingly rare.

CASE PRESENTATION: A 32-year-old woman undergoing cerebellopontine angle schwannoma excision developed intraoperative VAE. Despite successful initial management, she progressed to SIRS, bilateral pleural effusions, and ARDS. She required invasive ventilation, bilateral pleural drainage, vasopressor support, and advanced hemodynamic monitoring with PiCCO. Gradual improvement was observed with supportive care, and she was successfully extubated and discharged.

CLINICAL DISCUSSION: This case illustrates how micro air emboli can trigger severe inflammatory and pulmonary responses, mimicking sepsis and cardiac failure. Capillary leak and pulmonary endothelial injury are key mechanisms.

CONCLUSION

VAE can lead to serious complications including ARDS and SIRS. Early recognition and aggressive supportive management are essential for recovery.