Left Heart and Systemic Arterial Circulation Air Embolus During CT-Guided Lung Biopsy

Abstract

A transthoracic needle biopsy (TTNB) of the lung, commonly referred to as a "lung biopsy," is a commonly performed procedure in Interventional Radiology. It is usually associated with well-known risks including pneumothorax and hemothorax. One of the rare and lesser-known risks of TTNB, however, is a phenomenon called an air embolism. The term "air embolism" alone may be somewhat ambiguous, as it could indicate i) air entering the systemic veins, or ii) air entering the pulmonary veins. Here, we present a case of an air embolus entering the pulmonary veins. The pulmonary veins naturally drain into the left side of the heart (left atrium and ventricle) which provides oxygenated blood to the major arteries of the body including the coronary, carotid, and major abdominal visceral branches. Therefore, an air embolism in this vasculature can lead to potentially devastating hemodynamic consequences downstream.

Acute Coronary Artery Air Embolism Complicating a CT-guided percutaneous lung biopsy: A case report

“…Subsequently, the patient was placed in the Trendelenburg position. Previous research has shown that the Trendelenburg position has no significant effect on preventing bubbles in arteries from reaching the brain [ [14] , [15] , [16] ]; however, many physicians still place the patient in this position empirically in clinical practice [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ], and a recent analysis seems to indicate a good prognosis of patients in the Trendelenburg position in the treatment of symptomatic air embolism. This approach is controversial but still worth considering; complications, including airway edema and cerebral edema, need to be controlled [ 3 , 4 , 25 , 26 ].…”

Systemic Air Embolism: A Rare Complication of Transthoracic Computed Tomography-Guided Lung Biopsy

“…We present the case of an asymptomatic 74-year-old man who presented with systemic air embolism after transthoracic CT-guided lung biopsy was performed [1,2,[4][5][6]. Subsequent serial thoracic CT scans demonstrated the causal relationship as well as confirmed the gradual absorption of the intravascular air, showing total resolution of this clinical situation [1,2].…”

“…In fact, SAE can result from an incidental passage of air from the pulmonary vein to the left heart that can lead to coronary and brain infarction [1,3,4,6,7].…”

“…However, the incidence might be underestimated due to failure to diagnose this adverse event in asymptomatic patients as its early recognition is difficult [2,3,5,6,9,10]. Although SAE may be well tolerated, it can be difficult to manage and may lead to death, with a mortality incidence of 0.16% [4,7].…”

“…Post-procedure CT scans allow the detection of SAE [2,3,6,7,10]. Early recognition and prompt diagnosis are difficult but crucial and eventually lifesaving, preventing significant morbidity and mortality [1,3,4,6,7].…”