BACKGROUND Cerebral arterial air embolism is a life-threatening complication that can result in neurologic deficits or death. Sometimes it is iatrogenic, presented as a complication of invasive medical procedures. Here we describe a case of cerebral arterial air embolism secondary to iatrogenic left atrial-esophageal fistula, of which the diagnosis might be covered up by the complicated pathophysiologic changes. CASE PRESENTATION A 68-year-old man presented with unconsciousness hours after aphasia and right hemiplegia, accompanied with hematemesis and fever. He had a history of atrial fibrillation, treated by radiofrequency catheter ablation 1 month ago. Brain CT displayed massive air embolism in left hemisphere, as well as right parietal lobe. Chest CT demonstrated a focus of air in the left atrium, which highly suggested an atrial-esophageal fistula. The patient received high flow (6 L/min) oxygen therapy. Intravenous antibiotics including imipenem and vancomycin were administered together with crystalloid rehydration. Supportive therapies were given including intubation, mechanical ventilation and vasopressor use. Because of the patient's unstable condition and poor prognosis, surgical repair was considered but not pursued. The patient presented a very fast deterioration of cardiac function and circulatory failure, and finally died from cardiac arrest. CONCLUSIONS Clinicians must have a high index of suspicion for atrial-esophageal fistula for patients presenting with chest discomfort, new onset of stroke, upper gastrointestinal bleeding, and development of sepsis as long as 50 days after the ablation for atrial fibrillation. Urgent CT can ultimately establish the diagnosis in most cases.

中文翻译：

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医源性左房食管瘘继发性脑动脉栓塞：一例报告。

背景技术脑动脉栓塞是危及生命的并发症，可导致神经功能缺损或死亡。有时是医源性的，表现为侵入性医疗程序的并发症。在这里，我们描述了一例继发于医源性左房食管瘘的脑动脉栓塞症，其诊断可能被复杂的病理生理变化所掩盖。病例介绍一名68岁的男性在失语症和右偏瘫后数小时内出现意识不清，伴有呕血和发烧。他有心房颤动的病史，在1个月前通过射频导管消融术治疗。脑部CT显示左半球以及右顶叶出现大量空气栓塞。胸部CT显示左心房中有空气聚焦，强烈提示有食管瘘。患者接受高流量（6 L / min）的氧气治疗。静脉注射抗生素，包括亚胺培南和万古霉素，并配合晶体补液。给予支持疗法，包括插管，机械通气和使用升压药。由于患者的病情不稳定且预后较差，因此考虑但未进行手术修复。该患者表现出非常快速的心脏功能恶化和循环衰竭，最后因心脏骤停死亡。结论对于消融心房纤颤的患者，如果出现胸部不适，中风新发，上消化道出血和败血症的发展，临床医生必须高度怀疑其心房食管瘘。