Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy

Cheng, Hsiu-Lien; Chiang, K-H; Py, Chang; Chou, Ya-Hui; Huang, H-W; Chou, Andre; Ps, Yen

doi:10.1259/bjr/39096533

Cited by 29 publications

(28 citation statements)

References 7 publications

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“…Patients may be asymptomatic if the amount of air entering the chambers on the left side of the heart is relatively small, and cause no significant effect on hemodynamics . In coronary air embolism, patients may experience a transient loss of consciousness and their electrocardiography may reflect myocardial ischemia . In intracranial air embolism, patients may experience seizures or loss of consciousness .…”

Section: Biopsy Proceduresmentioning

confidence: 99%

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

Guo

Shi

et al. 2018

Thoracic Cancer

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Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.

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Section: Biopsy Proceduresmentioning

confidence: 99%

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

Guo

Shi

et al. 2018

Thoracic Cancer

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“…The cause of death is cardiac or cerebral infarction [9-11]. Aside from other factors such as accidental intravascular injection and paradox embolism due to a patent foramen ovale [12], three mechanisms in particular are responsible during PCNB: placing the tip of the needle in a pulmonary vein causing air to be aspirated [11,13], the formation of a bronchial-venous [14,15] or alveolar-venous fistula [15] with air passing into the pulmonary vein if the alveolar or bronchial pressure is high or the venous pressure too low [15], and passage of air via the pulmonary capillary bed from the pulmonary artery into the pulmonary venous system [16], e.g.…”

Section: Introductionmentioning

confidence: 99%

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

et al. 2012

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BackgroundDetection of risk factors for an air embolism in the left atrium, left ventricle, or systemic circulation (systemic air embolism, SAE) during a percutaneous core needle biopsy (PCNB) of the thorax.MethodsIn a retrospective observational study, all PCNBs of the thorax in 610 patients between 2007 and 2009 were analyzed. The SmartStep™ technique (General Electric) was used for the biopsy, with which the examiner can prepare a batch of three 1.25-mm or 2.5-mm collimated slices within a second using a foot switch in the CT room to check the needle position. The image data thus generated and the control CT scans that followed were examined retrospectively for the presence of intravascular air. Intravascular air was defined as two or more adjacent voxels with absorption values of < -200 HU in the left atrium, left ventricle, aorta, or arteries during or after the procedure. The univariate statistical analysis of categorical variables was made using 2 by 2 tables and the Fisher test. The groups were compared using the Mann-Whitney test. Finally, a multivariate logistic regression analysis was used to identify independent risk factors for the occurrence of an SAE.ResultsThe radiological incidence of an SAE during a PCNB was 3.8% (23/610 patients), whereas the clinically apparent incidence was 0.49%. Two patients developed clinical symptoms consisting of transient hemiplegia or transient amaurosis; one died due to a fatal SAE of the coronary arteries. The mortality was thus 0.16%. The depth of the needle in the lesion (Wald: 6.859), endotracheal anesthesia (Wald: 5.721), location of the lesion above the level of the left atrium (Wald: 5.159), and prone position of the patients (Wald: 4.317) were independent risk factors for the incidence of an SAE (p < 0.05 each). Using explorative criteria, the acute angle of the needle to the tumor surface, and the transition of ventilated lung were independent factors. The frequency of biopsies, needle penetration depth, and tumor location near the diaphragm or in the lower lobe also played a subordinate role, not however, the needle penetration depth through the lung.ConclusionIf possible, the PCNB should be performed under local anesthesia. We recommend avoiding endotracheal anesthesia and prone position. Whenever possible, patients should be positioned on the back in such a way that the tumor is lower than the left atrium. The tip of the needle should be within the tumor during the biopsy procedure.

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“…The characteristics of symptomatic air embolism, based on the present and previously reported cases, are summarized in the following section (3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In the majority of cases, the clinical symptoms of air embolism occur either during or immediately following needle biopsy.…”

Section: Discussionmentioning

confidence: 95%

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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Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy

Cited by 29 publications

References 7 publications

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

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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