Acute pulmonary edema and thrombocytopenia following venous air embolism during sitting position neurosurgery

Venous air embolism (VAE) is a well-known complication of sitting position neurosurgery which most characteristically manifests as mild to severe hemodynamic alterations. Development of pulmonary edema is a known, though infrequent, manifestation of VAE. We report here the occurrence of acute pulmonary edema without accompanying hemodynamic changes in a patient undergoing retromastoid craniotomy and tumor decompression in the sitting position. The patient required supportive treatment and elective ventilation for 11 days before the edema resolved. He also developed significant postoperative thrombocytopenia which though, was self-limiting. Thus, VAE may manifest with atypical manifestations like pulmonary edema and thrombocytopenia that can significantly contribute to postoperative patient morbidity.