Massive systemic arterial air embolism caused by an air shunt after blunt chest trauma: A case report

•An air shunt after blunt chest trauma can cause SAAE.•This is the first reported traumatic air shunt confirmed directly during surgery.•Clinical and operative finding can aid in earlier diagnosis and intervention of SAAE.•The bronchopulmonary vein fistula, the aortic and cardiac injury can become air shunts.•Pneumothorax and lung contusion can be risk factors for SAAE, as source of air. Systemic arterial air embolism (SAAE) is a rare but fatal condition, with only a few cases reported, and the detailed etiology underlying SAAE remains unknown. We report a first case of massive SAAE after blunt chest injury, wherein the presence of traumatic air shunt was confirmed by direct observation during surgery. We also summarize our experience with six other SAAE cases. A 68-year-old woman was admitted in a state of cardiac arrest after a fall. Emergency room thoracotomy determined complete transection of left main bronchus and left superior pulmonary vein. Postmortem computed tomography (CT) revealed full of air in the aortic arch, the descending aorta, and the great vessels. Therefore, one of the cause of death might be SAAE. An air shunt after blunt chest trauma can cause SAAE, and clinical signs and operative findings can provide clues for possible SAAE. The bronchopulmonary vein fistula, the aortic injury and full-thickness myocardial injury have the potential to become traumatic air shunts. In cases with a coexisting air shunt, pneumothorax, lung contusions and positive-pressure ventilation can be risk factors for SAAE, as sources of air continually entering the systemic arterial circulation. SAAE is caused by an air shunt following trauma. Clinical signs and operative findings summarized in this case should aid in the recognition of possible SAAE.