Silent Air Embolism of the Pulmonary Artery and Right Ventricle Due to Suspected Intravenous Substance Use Found Incidentally on Outpatient Imaging.

Pulmonary artery air embolism is a rare condition with significant morbidity and mortality. It most usually arises from iatrogenic entry of air into the venous system during surgeries and vascular access procedures. Most detected cases present with cardiopulmonary and neurological manifestations. It is exceedingly rare to find asymptomatic cases incidentally on imaging for other causes. Here, we describe the case of an elderly woman with ongoing chemotherapy sessions for her gynecologic malignancy, who was incidentally found to have pulmonary artery air embolism on an outpatient computed tomography (CT). The cause of this air embolism was suspected to be the unwitnessed episodes of intravenous drug use during her chemotherapy sessions. Although the patient had an asymptomatic and uncomplicated course, she was managed just as any symptomatic case would have been and safely discharged. This raises the point that an entity as dangerous as air embolism needs to be managed regardless of symptoms, in order to prevent all possible complications. This case highlights intravenous drug use as a potential non-iatrogenic cause of venous air embolism and also how some of them can be asymptomatic, yet warrant similar treatment as symptomatic ones.