Systemic air embolism after transthoracic lung biopsy: A case report and review of literature

Abstract

Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially life-threatening complication. We report a fatal case of air embolism to the cerebral and coronary arteries confirmed by head and chest CT, followed by a review of the literature.

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

“…The clinical presentation is similar to that of thromboembolic stroke syndrome, ranging from focal neurological deficits of rapid onset such as hemiplegia, confusion, or convulsions. Coronary artery air embolism can induce ECG changes typical of ischemia and infarction, dysrhythmias, and cardiac arrest [5,[7][8][9][10]. Systemic air embolism is a rare but severe complication of TTNB.…”

“…During the non-coaxial cutting needle biopsy technique, used at our institution, the previously described mechanism is not possible because the cutting needle prevents the entry of atmospheric air. The other possible way of the entry of air is the formation of a communication between air spaces inside the lungs, such as pulmonary cysts, bullae, cavitations, bronchi, and the pulmonary vein, and this complication is termed as an iatrogenically formed communicating fistula [8,10]. It is widely considered that the factors that lead to the increase of air pressure inside the airspace of the lungs, such as coughing, Valsalva maneuvers, or positive pressure ventilation, also increase the risk of air embolism.…”

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

“…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.…”

Massive Air Embolism After Lung Biopsy

“…The coaxial technique is often discussed as a risk factor for systemic air embolisms, but there are a number of cases described without the use of the coaxial technique. 1 In the presented case, we believe that positive pressure ventilation was the main reason for this fatal air embolism, with prone position being an additional risk factor. Furthermore, the chronic inflammatory process of the lung that had been present in our patient for several weeks is an additional risk factor 2 that interferes with hemostatic mechanisms that promote vessel occlusion and directly inhibits vessel contraction.…”

“…Moderate complication rates have been described, including pneumothorax (27%), intraparenchymal hemorrhage (11%), or hemoptysis (7%). 1 Systemic air embolism is an extremely rare and feared complication that is potentially fatal, reported previously to have an incidence of ≈0.02% to 0.7%. 2 However, it can be assumed that there is a much higher incidence of systemic air embolism because of clinically unapparent cases (0.4% to 3.8%).…”