A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting during Liver Transplantation

Abstract

Paradoxical air embolism (PAE) during orthotopic liver transplantation (OLT) is relatively common. However, small quantities of air have minimal clinical significance.1,2 Hepatopulmonary syndrome (HPS), a recognized sequeala of chronic liver disease, is caused by intra-pulmonary arteriolar vasodilation and presents as hypoxemia. These collaterals provide a route for PAE in the absence of a pressure gradient from the right to left sided heart chambers. To our knowledge, this is the first report of a clinically significant PAE via intrapulmonary shunts during OLT.