Massive Air Embolism in the Pulmonary Artery During Permanent Pacemaker Insertion

An elderly lady presented with syncope and was found to have complete heart block. She was planned for permanent pacemaker implantation the following day, and during the procedure, she developed an acute onset of dyspnea with hypotension, tachycardia, and her oxygen saturation on room air had dropped to 76%. After ruling out pneumothorax and myocardial infarction, we noticed that there was a massive air column floating in the pulmonary artery, which was visualized on cine-fluoroscopy. A provisional diagnosis of air embolism in the pulmonary artery was made, and she was managed with high-flow O2 and massive fluid boluses. Within 10 minutes, the patient improved with the disappearance of the air shadow on cine-fluoroscopy. Subsequently, the patient was discharged and improved dramatically.