Systemic arterial gas embolism (SAGE) as a complication of bronchoscopic lung biopsy: a case report and systematic literature review

Air embolism after transbronchial lung cryobiopsy: A case report

“…In particular, neurological symptoms were seen in 97% of patients, and cardiovascular symptoms such as arrhythmia, chest pain associated with myocardial infarction, hypotension, and cardiac arrest were reported in 28% of patients. The onset of symptoms is usually within 30 minutes of biopsy, although in 28% of cases, there is delayed loss of consciousness or hemiparesis after sedation is withdrawn 6 . In the present case, the onset of the infarction occurred after the patient started walking, and it is thought that intracardiac air caused the infarction to the cerebral artery during positional change from supine to upright.…”

“…VAE causes serious symptoms due to occlusion of cerebral arteries, coronary arteries, and other cardiovascular arteries. The entry of air into the cardiovascular system is required for direct traffic between the pulmonary veins and lumina, such as alveoli and bronchioles, as well as a pressure gradient that allows gas to flow into the venous annulus 6 . However, pathology does not always show the pulmonary veins, and the cause is unknown in some cases 7 .…”

“…Symptomatic VAE with cerebrovascular or cardiovascular air has a poor prognosis, with a mortality rate of 26.4%–28% 67 . However, many cases of asymptomatic VAE have been reported in CT‐guided lung biopsies, and the prognosis is very good 10 .…”

“…Administration of 100% oxygen is the recommended treatment for VAE, but positive pressure should be limited when tracheal intubation is used. Although there are physiological mechanisms supporting the use of hyperbaric oxygen therapy, which is thought to reduce the influx of gas into the vessels, the therapeutic effect is controversial 6 . Patient positioning is also a factor in air embolization.…”

“…The entry of air into the cardiovascular system is required for direct traffic between the pulmonary veins and lumina, such as alveoli and bronchioles, as well as a pressure gradient that allows gas to flow into the venous annulus. 6 However, pathology does not always show the pulmonary veins, and the cause is unknown in some cases. 7 In this case, the collected tissue showed fine venules, but no large veins.…”