Frequency and Risk Factors for Air Embolism in Computed Tomography Fluoroscopy–Guided Biopsy of Lung Tumor With the Use of Noncoaxial Automatic Needle

Abstract

The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy-guided lung biopsies using noncoaxial automatic needle.Materials and Methods: Between February 2014 and December 2019, 204 CT fluoroscopy-guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed. Results:The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein ( P = 0.0478) and higher location relative to left atrium ( P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively. Conclusions:In CT fluoroscopy-guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.

Feasibility and safety of computed tomography-guided intrapulmonary injection of indocyanine green for localization of peripheral pulmonary ground-glass nodules

“…Several risk factors for fistula formation have been identified in previous studies, including the length of the needle path through the ventilated lung, the depth of needle penetration into the nodule, and the number of biopsy samples obtained ( 33 , 34 ). A recent study found a higher radiological incidence of air embolism of 3.92%, which was unexpectedly higher than that reported in previous research; however, it should be mentioned that many of the detected cases were asymptomatic, and only 0.98% of patients experienced symptoms related to air embolization ( 35 ). In our study, no cases of air embolism were detected in either the ICG group or the hook-wire group.…”

Cerebral Air Embolism: A Case of a Rare Transthoracic Needle Biopsy Complication

“…Air bubbles may enter the pulmonary veins by the accidental placement of the needle tip within a pulmonary vein, followed by air injection into the needle; another mechanism consists in the creation of a fistula between a bronchus and an adjacent pulmonary vein by the inadvertent placement of the needle through both structures, allowing passage of air into the pulmonary vein. It’s not difficult to understand these mechanisms considering that pulmonary vein pressure is normally around 10 cmH2O [ 12 ].…”