Pneumocephalus Due to a Bronchoatrial Fistula

This clinical image report describes a 61-year-old man with stage IIIB squamous-cell lung carcinoma who developed sudden seizurelike activity during a restaging CT. Previously treated with chemotherapy, he was found to have diffuse pneumocephalus on head CT and a bronchoatrial fistula on chest imaging linking a cavitary right lower lobe lesion to the left atrium. The pneumocephalus was attributed to an air embolism originating from this fistula. Despite emergent management, the patient died in the intensive care unit. This rare case underscores the catastrophic potential of air embolism from abnormal thoracic communications in patients with pulmonary malignancy.

This clinical image report describes a 61-year-old man with stage IIIB squamous-cell lung carcinoma who developed sudden seizurelike activity during a restaging CT. Previously treated with chemotherapy, he was found to have diffuse pneumocephalus on head CT and a bronchoatrial fistula on chest imaging linking a cavitary right lower lobe lesion to the left atrium. The pneumocephalus was attributed to an air embolism originating from this fistula. Despite emergent management, the patient died in the intensive care unit. This rare case underscores the catastrophic potential of air embolism from abnormal thoracic communications in patients with pulmonary malignancy.