Systemic air embolism during preoperative pulmonary marking with a short hook wire and suture system under CT fluoroscopy guidance

Abstract

We encountered a case of systemic air embolism during preoperative pulmonary marking with a short hook wire and suture system under CT fluoroscopy guidance. The pulmonary tumor was present in the right S3, and the procedural position was supine. The patient experienced cardiac symptoms, and systemic air embolism was confirmed on CT images. With the patient in the Trendelenburg position, 100% oxygen was immediately administered as therapy for the embolism. Subsequently, the symptoms and systemic air embolism were resolved. The patient underwent video-assisted thoracoscopic wedge resection after 5 days and was then discharged without any sequelae.

Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance

“…Although there was some limited radiation exposure from the CT-scan, our system is relatively easy to perform without the need for a fluoroscopy guide [7,8] or radioprobe [9] during surgery. Fortunately, we did not experience any cases of systemic air embolism, which, although relatively rare, is potentially fatal [10].…”

Preoperative computed tomography-guided hook-wire positioning of pulmonary nodules

“…Hence, hook-wire positioning was performed for pulmonary nodules on the truncated edge of the lung (e.g., posterior section of the lower lobe) at a depth of more than 2 cm. The thoracoscopic wedge resection has many risks, e.g., positive incisal margins, removal of excessive pulmonary tissue, failure to guarantee a rational distance between the incisal margins and the nodules, and retention of foreign matter due to cutting of the steel wire (Iguchi et al, 2009;Magistrelli et al, 2009). Thus, care should be taken in performing a wedge resection for deep pulmonary nodules, and preparations should be made for the resection of pulmonary segments or lobes (Miyoshi et al, 2009).…”

Thoracoscopic wedge lung resection using virtual-assisted lung mapping

“…[3][4]12 First, bronchoscopic marking appears to be associated with a lower risk of complications, particularly potentially fatal air embolisms. [5][6][7][8][9][10] Second, bronchoscopic approaches have better access to some areas within the thorax (e.g., the apex). Third, dye marking techniques are associated with a lower risk of loss of marks and of leaving a piece of apparatus (e.g.…”

“…2 Most importantly, potentially fatal air embolisms, which have been reported in percutaneous marking techniques, are less likely to occur with bronchoscopic approaches. [5][6][7][8][9][10] Moreover, dye markings are generally associated with a lower risk of marker dislodgement and loss than are wire or coil hook methods. 1,11 In the VAL-MAP technique described herein, we utilized virtual bronchoscopy and 3-dimensional images constructed from thin-slice CT to avoid the previously reported use of real-time CT for bronchoscopic markings and thus avoid excessive radiation exposure to the bronchoscopist.…”