Systemic Air Embolization Originating from a Pleural Air Leak via a Left Ventricular Assist Device Cannula Anastomosis Site

A patient presented with cardiogenic shock, and a left ventricular assist device (LVAD) was inserted. Transthoracic echocardiography demonstrated air in the left side of the heart whenever the patient coughed. A chest x-ray and computed tomography of the chest did not reveal a pneumothorax. Air appeared to enter the left atrium (LA) around the LA cannula. The working diagnosis was a right pleural tear with intermittent passage of air from the pleural space (supra-atmospheric during coughing) into the LA (around the cannula), which contained a large-bore LVAD cannula on -40 mm Hg suction. This was confirmed by inserting a right-sided chest drain, and no air appeared during coughing. This case demonstrates an unusual complication of LVAD use (systemic air embolization) and highlights the point of variable physiology during dynamic versus static imaging procedures.