Venous Air Embolism Following Intraosseous Access: A Case Report and Echocardiographic Findings

Venous air embolism (VAE) is a rare but potentially life-threatening complication of intraosseous access. We report the case of a 57-year-old woman who presented to the emergency department following deliberate self-poisoning and subsequently developed VAE associated with intraosseous access. Transthoracic echocardiography revealed acute cor pulmonale with air bullae migrating from the inferior vena cava to the right heart cavities and the pulmonary circulation, indicating massive VAE. Associated patent foramen ovale was diagnosed by transesophageal echocardiography, suggesting paradoxical embolism. This case highlights the importance of caution with intraosseous access, especially when using semirigid containers and pressure-infusion devices. Emergency and intensive-care physicians should be aware of the VAE risk associated with semirigid containers to promptly recognize and treat VAE events.