When Coughing Can Cause Stroke—A Case-Based Update on Cerebral Air Embolism Complicating Biopsy of the Lung

Kau, Thomas; Rabitsch, Egon; Celedin, Stefan; Habernig, Sandra; Weber, Jörg; Hausegger, K. A.

doi:10.1007/s00270-008-9339-z

Cited by 29 publications

(21 citation statements)

References 22 publications

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“…All patients were seen again by the radiologist in a final consultation two to four hours after the biopsy for a control CT scan, but there are no systematic records of this talk. Unfortunately, there is no record of the probably very important factor "coughing" [27]. Finally, it must be stated that not CT, but transesophageal and probably transcutaneous echocardiography must be considered the gold standard diagnostic measure.…”

Section: Discussionmentioning

confidence: 99%

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

et al. 2012

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BackgroundDetection of risk factors for an air embolism in the left atrium, left ventricle, or systemic circulation (systemic air embolism, SAE) during a percutaneous core needle biopsy (PCNB) of the thorax.MethodsIn a retrospective observational study, all PCNBs of the thorax in 610 patients between 2007 and 2009 were analyzed. The SmartStep™ technique (General Electric) was used for the biopsy, with which the examiner can prepare a batch of three 1.25-mm or 2.5-mm collimated slices within a second using a foot switch in the CT room to check the needle position. The image data thus generated and the control CT scans that followed were examined retrospectively for the presence of intravascular air. Intravascular air was defined as two or more adjacent voxels with absorption values of < -200 HU in the left atrium, left ventricle, aorta, or arteries during or after the procedure. The univariate statistical analysis of categorical variables was made using 2 by 2 tables and the Fisher test. The groups were compared using the Mann-Whitney test. Finally, a multivariate logistic regression analysis was used to identify independent risk factors for the occurrence of an SAE.ResultsThe radiological incidence of an SAE during a PCNB was 3.8% (23/610 patients), whereas the clinically apparent incidence was 0.49%. Two patients developed clinical symptoms consisting of transient hemiplegia or transient amaurosis; one died due to a fatal SAE of the coronary arteries. The mortality was thus 0.16%. The depth of the needle in the lesion (Wald: 6.859), endotracheal anesthesia (Wald: 5.721), location of the lesion above the level of the left atrium (Wald: 5.159), and prone position of the patients (Wald: 4.317) were independent risk factors for the incidence of an SAE (p < 0.05 each). Using explorative criteria, the acute angle of the needle to the tumor surface, and the transition of ventilated lung were independent factors. The frequency of biopsies, needle penetration depth, and tumor location near the diaphragm or in the lower lobe also played a subordinate role, not however, the needle penetration depth through the lung.ConclusionIf possible, the PCNB should be performed under local anesthesia. We recommend avoiding endotracheal anesthesia and prone position. Whenever possible, patients should be positioned on the back in such a way that the tumor is lower than the left atrium. The tip of the needle should be within the tumor during the biopsy procedure.

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Section: Discussionmentioning

confidence: 99%

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

et al. 2012

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“…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.…”

Section: Discussionmentioning

confidence: 95%

“…Studies have indicated that pathological pulmonary abnormalities may predispose a patient to an increased risk of air embolism (12,24). It is believed that, following lung biopsy and needle withdrawal, a large number of alveolar-venous or bronchial-venous fistulas can develop along the needle trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…Extravasated and then coagulated blood may promote extravascular tamponade, which can prevent air in the alveoli or bronchi from entering the vein; however, pathological pulmonary abnormalities, such as inflammation, forms of vasculitis, e.g. Wegener's granulomatosis, and interstitial disease, which are risk factors of air embolism, may interfere with the healing process and result in prolonged exposure of the vessel lumen to the airway (3,24). Ghafoori and Varedi (11) presumed that an increased probability of air embolism could be associated with the size of the needle and the coaxial techniques.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

Bian

Sheng-yuan

et al. 2015

Experimental and Therapeutic Medicine

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Abstract.Computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) of the lung is a widely accepted and frequently performed interventional radiological procedure for the diagnosis of various pulmonary lesions. Common complications are usually mild and self-limited; however, air embolism is an extremely rare but potentially fatal complication. This study reports a case of fatal air embolism in the coronary and spinal arteries that resulted from a complex CT-guided PCNB of the lung. The present case suggests that multiple precautions may not eliminate the risk of the fatal air embolism resulting from the procedure of CT-guided PCNB. Prompt recognition and urgent resuscitation are crucial for initial stabilization, allowing subsequent diagnostic confirmation and appropriate treatment. The common characteristics of symptomatic air embolism, based on the case reported and a review of the literature, are summarized in the present study in order to provide recommendations for clinical practice.

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“…In addition, transpulmonary puncture carries the potential risk of causing systemic air embolism, as is the case with lung biopsy. 6,7 We think a percutaneous transhepatic approach through the diaphragmatic fi stula, which has not been previously reported, has the advantage to avoid these risks of the transpulmonary approach for treating such cases.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess

et al. 2011

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Liver abscesses occurring just below the diaphragm can penetrate or perforate the thoracic cavity, resulting in lung abscess or pyothorax. Although surgical or percutaneous transpleural drainage is often required in such cases, the latter approach has some risks, including hemothorax and bronchopleural fistula formation when the cavity is surrounded by normal lung parenchyma. The present report describes a treatment technique of percutaneous transhepatic drainage through the diaphragmatic fistula to avoid the risks of a transpulmonary approach in a case of lung abscess caused by a penetrating liver abscess.

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When Coughing Can Cause Stroke—A Case-Based Update on Cerebral Air Embolism Complicating Biopsy of the Lung

Cited by 29 publications

References 22 publications

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

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

Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess

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