Systemic air embolism depicted on systematic whole thoracic CT acquisition after percutaneous lung biopsy: Incidence and risk factors

Monnin-Bares, Valérie; Chassagnon, Guillaume; Vernhet-Kovacsik, Hélène; Zarqane, Hamid; Vanoverschelde, Juliette; Picot, Marie Christine; Bommart, Sébastien

doi:10.1016/j.ejrad.2019.05.016

Cited by 27 publications

(57 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Common complications include pneumothorax, parenchymal hemorrhage and hemoptysis, which are systematically screened for, and have a satisfying evolution when treated. Nevertheless, systemic air embolism (SAE), which is defined as the presence of gas in the systemic circulation after percutaneous lung biopsy, is not a rare complication, with an incidence of 4.8% according to Monnin-Barres et al [1]. Its occurrence can have fatal consequences.…”

Section: Discussionmentioning

confidence: 99%

Acute Coronary Artery Air-Embolism after Percutaneous Lung Biopsy

Grandjean

Galderoux

Cousin

2020

Journal of the Belgian Society of Radiology

View full text Add to dashboard Cite

A 62-year-old female underwent a Computed Tomography (CT)-guided percutaneous lung biopsy for a suspicious right upper lobe nodule. After biopsy, the patient was repositioned from prone to supine position on the CT table and presented immediately with acute thoracic pain radiating to the jaws, general discomfort and nausea. Supportive care (high flow oxygen therapy) was administered and a control chest CT depicted air emboli in the aortic bulb (Figure 1a), in the right coronary artery (Figures 2a-b) and in the right m arginal artery (Figure 3a-3b). Oxygen therapy was continued and antalgic treatment was introduced. The patient was admitted to the Coronary Care Unit for close surveillance and immobilization. No myocardial ischemia was seen on echocardiography, neither cardiac enzyme elevation nor electrocardiographic modifications were seen.

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Coronary Artery Air-Embolism after Percutaneous Lung Biopsy

Grandjean

Galderoux

Cousin

2020

Journal of the Belgian Society of Radiology

View full text Add to dashboard Cite

show abstract

“…In the methodological quality assessment, 19 articles with information on the incidence of symptomatic air embolism [3,5,6,9,10,14,18,19,[23][24][25][26][27][28][29][30][31][32][33] and 90 articles with information on the risk factors for symptomatic air embolism and unfavorable outcomes were evaluated [6, 9, 14-19, 24,26,29,, respectively. For the incidence of symptomatic air embolism, all 19 articles were considered high quality, meeting all four items adequately.…”

Section: Eligible Studies and Methodological Qualitymentioning

confidence: 99%

Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis

et al. 2020

View full text Add to dashboard Cite

Objectives To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. Methods We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. Results The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048–0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029–34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103–91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725–14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149–9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309–20.447; p = 0.019). Conclusion The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. Key Points • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.

show abstract

“…This is in contradistinction to the rates of SAGE during percutaneous lung biopsy, which are reported to be between 0.06% (34) and 0.9% (35) in the latter study, 16 of 19 instances of SAGE were asymptomatic and only identified during routine head and chest CT after biopsy. A retrospective review of 559 percutaneous lung biopsy cases at one institution revealed a radiographic incidence of 4.8%, despite a clinical incidence of only 0.17% (36). These findings suggest that asymptomatic SAGE may be much more common after bronchoscopic biopsy than is currently known, and may contribute to the otherwiseidiopathic acute cardiovascular complications associated with bronchoscopy-cited as 0.068% by Asano et al…”

Section: Pathophysiology and Epidemiologymentioning

confidence: 97%