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Air embolism simulating atypical pneumonia

An 18-year-old man was admitted for allogeneic stem cell transplantation in first remission of acute myeloid leukaemia. Prior to conditioning therapy, he had no infection, and a chest computed tomography (CT) scan was normal. Sixty minutes after the first irradiation with 2 Gy the patient presented with severe dyspnoea, bronchial spasm and visual defect. Physical examination revealed air embolism due to an open lid of the jugular vein central line. After occlusion of the leakage the patient recovered completely within minutes. A CT scan performed 1 h later showed disseminated atypical infiltrates in both lungs (Figure). Due to the patient’s poor immunity, the most relevant differential diagnosis was fungal pneumonia. However, in aCT scanperformed 14 h later all atypical infiltrates had vanished indicating that the infiltrates were caused by the air embolism. The patient was discharged from hospital 1 month after transplantation, with normal CT findings.