• Cerebral air embolism:
  • Altered mental status
  • Headache
  • Dizziness
  • Paresthesias
  • Visual disturbances
  • Aphasia
  • Minor motor weakness
  • Paralysis
  • Seizures
  • Asymmetric pupils
  • Hemianopia
• Coronary arterial embolism:
  • Chest pain
  • Cardiac arrhythmias
  • Cardiac arrest
• Renal arterial embolism:
  • Hematuria
  • Proteinuria
  • Renal failure
• Mucocutaneous arterial embolism:
  • Cyanotic marbling of the skin
  • Focal area of pallor in the tongue

History

Rapid onset of new neurologic, cardiac, renal, or mucocutaneous symptoms after completion of a scuba dive or surgery

Physical Exam

• Neurologic signs:
  • Altered mental status
  • Aphasia
  • Minor motor weakness
  • Paralysis
  • Seizures
  • Asymmetric pupils
• Cardiac signs:
  • Arrhythmias
  • Arrest
• Renal signs:
  • Hematuria
  • Proteinuria
  • Elevated blood urea nitrogen (BUN)/creatinine
• Mucocutaneous signs:
  • Cyanotic marbling of the skin
  • Focal area of pallor in the tongue

Diagnostic Tests and Interpretation

Lab
No specific tests exist for arterial gas embolism.

Initial Labs
Urinalysis and basic metabolic profile (to check for renal involvement)

Imaging

• CXR to rule out pneumothorax
• ECG
• CT scan: Changes often very subtle
• MRI: Sometimes can show increased volume of water in injured tissue (not very reliable)

Differential Diagnosis

Decompression sickness