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Abstract: SA-PO438

A Bubbly Catastrophe: A Case of Air Embolism Presenting as Ischemic Stroke in a Hemodialysis Patient

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Abd algayoum, Randa, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Andrea, Tyler, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States

Air embolism is a rare but potentially catastrophic complication and can often be fatal. In humans, a volume of 100–300 mL air is considered fatal. Due to the technological safeguards implemented in hemodialysis machines, symptomatic air embolisms are now exceedingly rare. We present a case of ischemic stroke and cerebral edema due to air embolism in a hemodialysis patient.

Case Description

A 76-year old male with history of multiple myeloma, lung cancer, and end-stage kidney disease on hemodialysis through tunneled dialysis catheter, presented for evaluation of stroke symptoms. Patient developed right gaze preference, left hemiparesis and dysarthria at his diaysis center after rinse back. No significant hemodynamic compromise and no alarms reported. Admission CT angiogram of head and neck revealed no acute intracranial abnormalities or infarct on perfusion imaging. Deemed not a candidate for thrombolytic therapy. MRI brain showed no acute intracranial abnormalities, markedly motion degraded. On the following hospital day, patient developed worsening lethargy and weakness. Follow-up CT head revealed cerebral edema involving the middle cerebral and anterior communicating artery territories on the right side with small focus of air in the right vertex sulcus which was also present on initial head CT scan (figure) consistent with air embolism, not previously reported but commented on in retrospect. Patient underwent emergent hyperbaric oxygen treatments. Following 3 sessions, patient experienced significant improvement in symptoms and was subsequently discharged to a rehabilitation facility.


Despite the technological safeguards in new hemodialysis machines, though rare air embolism can still occur during hemodialysis nowadays mostly due to human error. Our case highlights the importance of implementing preventative measures, ensuring adequate staff training and the need for high level of vigilance required for early diagnosis and prompt management.

Black arrows pointing to the air embolisms in figure 1 and figure 2, imaging obtained on initial presentation and the following day respectively.