Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

This is a case report of a 53-year-old woman who presented to the Emergency Department after sustaining a tangential gunshot wound to the left anterior chest wall. On arrival, the patient was somnolent, hypotensive, hypoxic, and had impaired speech. The patient's cardiopulmonary status stabilized quickly after fluid resuscitation and supplemental oxygen. Because the initial chest radiograph revealed only mild vascular congestion without traumatic injuries, a computed tomography angiogram of the chest was subsequently obtained, which showed air within the right ventricle and pulmonary arteries. Significant bilateral pulmonary infiltrates were also noted without evidence of pneumothorax, penetrating lung, or vascular injuries. There are numerous case reports of venous air embolism (VAE) after penetrating neck, chest, and abdominal injuries, surgical procedures, or secondary to unintentional air injection through venous catheters. Due to the wide range of neurological and cardiopulmonary clinical presentations, the non-specific signs and symptoms of VAE may frequently be attributed to other causes, especially in the setting of trauma. An overview of the pathophysiology, clinical presentation, diagnosis, and treatment of VAE is presented, with emphasis on diagnostic imaging modalities.