An unusual case is presented of a tourist who developed fatal cerebral air embolism, pneumomediastinum and pneumopericardium while ascending from low altitude to Europe's highest railway station. Presumably the air embolism originated from rupture of the unsuspected bronchogenic cyst as a result of pressure changes during the ascent. Cerebral air embolism has been observed during surgery, in scuba diving accidents, submarine escapes and less frequently during exposure to very high altitude. People with known bronchogenic cysts should be informed about the risk of cerebral air embolism and surgical removal should be considered. Cerebral air embolism is a rare cause of coma and stroke in all activities with rapid air pressure changes, including alpine tourism, as our unfortunate tourist illustrates.
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Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent It has not been possible to trace the family who left Switzerland shortly after the patient died because their address has changed. However, publication is acceptable under Swiss law because there was no issue of any mismanagement, and the case is an important warning and so we are publishing it without explicit consent. We have also anonymised some of the patient's details.
Competing interests None.
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