Near-fatal air embolism: Fibrin sheath as the portal of air entry

Complications of central venous catheters occur in less than 1% of all insertions. Of these, pulmonary air embolism is a rare though often fatal complication. Possible mechanisms include opening of the line to the atmosphere during use and poor technique during insertion or removal. There has also been speculation that the presence of a fibrin sheath after removal might be a mechanism for air entry. We present a case of a near-fatal pulmonary air embolus with documentation of air in the pulmonary outflow trunk and a residual air-filled fibrin tract seen on computed tomography.