Air Embolism and Needle Track Implantation Complicating CT-Guided Percutaneous Thoracic Biopsy: Single-Institution Experience

Ibukuro, Kenji; Tanaka, R.; Takeguchi, Takaya; Fukuda, Haruki; Abe, Shoko; Tobe, Kimiko

doi:10.2214/ajr.08.2214

Cited by 71 publications

(53 citation statements)

References 25 publications

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“…The incidence of hemorrhage was 1% (95% CI 0.9-1.2%) and blood transfusion was required in 18% [4]. Although the frequency of fatal complications like pleural dissemination and air embolism was low, these were also reported [38]. No complications directly caused by VBN were reported, and the VBN complication rate was equivalent to that on conventional bronchoscopy [39] and far lower than that on TTNA, which is a marked advantage.…”

Section: Advantages Of Vbnmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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Virtual bronchoscopic navigation (VBN) is a method in which the bronchoscope is guided on the bronchial route to a peripheral lesion using virtual bronchoscopic images. In reports on VBN for peripheral pulmonary lesions searched in PubMed as of November 2013, the diagnostic yield by ultrathin bronchoscopy in combination with computed tomography and VBN was within the range of 65.4-81.6%. Using endobronchial ultrasonography with a guide sheath (EBUS-GS) and VBN, it was between 63.3 and 84.4%, and using X-ray fluoroscopy and VBN, it was between 62.5 and 78.7%. The overall diagnostic yield was 73.8% [95% confidence interval (CI) 70.9-76.8%] and that for lesions ≤2 cm was 67.4% (95% CI 63.3-71.5%). These values indicate high diagnostic rates. In randomized comparative trials, the combination of VBN with EBUS-GS improved the diagnostic yield and shortened the examination time. The diagnostic yields for lesions in the right upper lobe, those invisible on posterior-anterior radiographs and those located in the peripheral third of the lung field were improved by VBN on ultrathin bronchoscopy in combination with X-ray fluoroscopy. The usefulness of VBN was also found on meta-analysis. Taken together, VBN is a promising navigational bronchoscopy method as it requires no specific training, has a low overall complication rate of 1.0% (95% CI 0.2-1.8%) and does not directly induce or cause severe complications. To maximize the full potential of VBN and promote its use, investigation of cases in which it is useful, determination of the optimum combination of procedures, a cost/benefit analysis and advancement of the VBN system are warranted.

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Section: Advantages Of Vbnmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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“…The complications of TFNAB in lungs include pneumothorax, haemoptysis, air embolism and needle tract metastasis [1,3,5,11,12]. In TFNAB using a C-arm CBCT system by Jin et al [7], the overall complication rate was reported as 38%, which comprised pneumothorax (25.4%), haemoptysis (14.1%) and chest pain (1.4%).…”

Section: Introductionmentioning

confidence: 99%

Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system: diagnostic accuracy and post-procedural complications

Lee

Chong²,

Seo³

et al. 2012

BJR

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Objective: The purpose of our study was to evaluate the diagnostic accuracy of transthoracic fine-needle aspiration biopsy (TFNAB) using a C-arm cone-beam CT (CBCT) system and to assess risk factors for immediate post-procedural complications in patients with lung lesions. Methods: From October 2007 to April 2009, 94 TFNAB procedures using a C-arm system were studied in 91 patients with pulmonary lesions a chest CT scans. We retrospectively reviewed the patients' radiological and histopathological findings. We evaluated the lesion size, lesion abutted to pleura and presence or absence of emphysema along the needle path, lesion depth, visibility of target lesion and patient's position. Pneumothorax and pulmonary haemorrhage were assessed after TFNAB. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analysed. Results: In 94 TFNAB procedures, 58 lesions were malignant and 36 were benign. The sensitivity, specificity, PPV, NPV and overall diagnostic accuracy rate of TFNAB were 93.1%, 100%, 100%, 90% and 97.9%, respectively. Pneumothorax was developed in 24 procedures. None of the parameters showed significant impact on the frequency of the pneumothorax. Overall haemorrhage occurred in 43 procedures. The incidence of overall haemorrhage was higher in patients with smaller lesions, longer pleural distance and pleural abutted lesions (p,0.05). Differences in visibility at projection radiographs were statistically significant between patients with or without perilesional haemorrhage (p,0.05). Conclusion: Transthoracic fine-needle aspiration biopsy using a C-arm CBCT system is feasible for imaging guidance of lung lesion and early detection of the proceduralrelated complications.

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“…Common complications include pneumothorax and pulmonary hemorrhage, both of which are known to be generally self-resolving with no clinical intervention required. Air embolism is a potentially life-threatening but extremely rare complication, with an estimated incidence of 0.02-0.06% (1,2); however, the incidence of air embolism is considered to be underestimated due to undiagnosed asymptomatic patients (3)(4)(5). The present study reports a case of air embolism in the coronary and spinal arteries, which, following a CT-guided PCNB of the lung, resulted in sudden mortality.…”

Section: Introductionmentioning

confidence: 71%

Systemic air embolism as a complication of CT-guided percutaneous core needle lung biopsy: A case report and review of the literature

Sun

Bian

Sheng-yuan

et al. 2015

Experimental and Therapeutic Medicine

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Abstract.Computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) of the lung is a widely accepted and frequently performed interventional radiological procedure for the diagnosis of various pulmonary lesions. Common complications are usually mild and self-limited; however, air embolism is an extremely rare but potentially fatal complication. This study reports a case of fatal air embolism in the coronary and spinal arteries that resulted from a complex CT-guided PCNB of the lung. The present case suggests that multiple precautions may not eliminate the risk of the fatal air embolism resulting from the procedure of CT-guided PCNB. Prompt recognition and urgent resuscitation are crucial for initial stabilization, allowing subsequent diagnostic confirmation and appropriate treatment. The common characteristics of symptomatic air embolism, based on the case reported and a review of the literature, are summarized in the present study in order to provide recommendations for clinical practice.

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Air Embolism and Needle Track Implantation Complicating CT-Guided Percutaneous Thoracic Biopsy: Single-Institution Experience

Abstract: The incidence of air embolism with clinical symptoms and needle track implantation complicating percutaneous thoracic biopsy is more frequent than the previously reported rate.

Cited by 71 publications

References 25 publications

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system: diagnostic accuracy and post-procedural complications

Systemic air embolism as a complication of CT-guided percutaneous core needle lung biopsy: A case report and review of the literature

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