Percutaneous Transthoracic Needle Biopsy Complicated by Air Embolism

Life-Threatening Complication of Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: Systemic Arterial Air Embolism

“…Air embolism is a considerably uncommon complication; but it can lead to myocardial infarction, arrhythmia, and stroke; and can be fatal. It has a 0.02-to-0.007% incidence after percutaneous transthoracic biopsy [6][7][8]. Among the recently published articles; in the report of Hiraki et al including 4 cases, none of the air embolisms ended fatally [1].…”

“…Detection of free air images are noted in cerebral arteries, aorta and coronary arteries after lung biopsies [1,7,8]. Consequently; depending on the vulnerability of the end-organs to hypoxia, the volume of air and the extent of the involved area, clinical picture may range from a situation of mild temporary loss of consciousness to death, which is the most catastrophic complication [1,7,8]. Hyperbaric oxygen therapy is the primary treatment method.…”

“…It diminishes the air volume, number of obstructive air bubbles and endothelial damage [9]. If this primary treatment modality is inaccessible at all times; the Trendelenburg position to reduce the cerebral embolisation risk and 100 % supportive oxygen therapy should be applied to the patient [7]. In any case; early diagnosis is very important for successful treatment.…”

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

“…Some authors consider larger needle diameter as a risk factor [8], although others have reported air embolism with both 18-gauge and 22-gauge needles [6]. To prevent inadvertent ingress of air, the biopsy procedure for pulmonary lesions in our institute follows the principle of exchanging the internal stylet of the introducer needle for the biopsy needle immediately, and vice versa.…”

Air Embolism During CT-Guided Transthoracic Needle Biopsy

“…14 In cases of venous AE, the patient should be positioned left side down in order to gather intracardiac air in the apex of the right ventricle and to prevent outfl ow to the lungs or to the left ventricle in case of patent ovale foramen. 15 Although many groups recommend application of right lateral decubitus and Trendelenburg position if air bubble is detected in the left ventricle (before it embolizes to brain), 16 some investigators are of the opinion that buoyancy of gas bubbles is not suffi cient to counteract the blood fl ow and they recommend the use of fl at supine position to avoid aggravation of cerebral oedema that could develop in these patients. 17 Due to the good outcome of our patient who was kept in head-down position, we prefer this position in the immediate management of AE.…”