Cough-induced bubbles formation in the heart: Is it related with a poor prognosis?

In current practice, it is not well-known whether the development of air bubbles spontaneously in the heart during routine transthoracic echocardiography examination has a clinical consequence. Even though there have been published case reports regarding the formation of air bubbles due to iatrogenic reasons, we could not find a case of a patient demonstrating spontaneous air bubbles formation due to only coughing. Thus, in this report, we present a case of an adult patient who had unexpected air bubbles in the heart after coughing. Furthermore, the patient experienced a catastrophic cerebrovascular accident after diagnosing such an event in the same day. We thought that spontaneously occurring air bubbles in the heart might have resulted in cerebrovascular accident by passing through patent foramen ovale, which we have diagnosed after we had seen that the spontaneously occurred air bubbles had also appeared in left chambers. To our knowledge, this might be the first case of such a patient in the literature. <Learning objective: The appearance of cough-induced air bubbles in the left heart might be a precursor to peripheral air embolism, and thus, predictive of very poor prognosis. Thus, medical workers should be aware of this poor finding.>.