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Air embolism in CT-guided transthoracic needle biopsy: emphasis on pulmonary vein injury

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Abstract

Objective

To assess whether pulmonary vein injury is detectable on CT and associated with air embolism after percutaneous transthoracic needle biopsy (PTNB) in a tertiary referral hospital.

Methods

Between January 2012 and November 2021, 11,691 consecutive CT-guided PTNBs in 10,685 patients were retrospectively evaluated. Air embolism was identified by reviewing radiologic reports. Pulmonary vein injury was defined as the presence of the pulmonary vein in the needle pathway or shooting range of the cutting needle with the presence of parenchymal hemorrhage. The association between pulmonary vein injury and air embolism was assessed using logistic regression analysis in matched patients with and without air embolism with a ratio of 1:4.

Results

A total of 27 cases of air embolism (median age, 67 years; range, 48–80 years; 24 men) were found with an incidence of 0.23% (27/11,691). Pulmonary vein injury during the procedures was identifiable on CT in 24 of 27 patients (88.9%), whereas it was 1.9% (2/108) for matched patients without air embolism The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]). In univariable and multivariable analyses, pulmonary vein injury was associated with air embolism (odds ratio, 485.19; 95% confidence interval, 68.67–3428.19, p <.001).

Conclusion

Pulmonary vein injury was detected on CT and was associated with air embolism. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT may reduce air embolism risk.

Key points

• Pulmonary vein injury during CT-guided biopsy was identifiable on CT in most of the patients (88.9% [24/27]).

• The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]).

• Avoiding the distinguishable pulmonary vein along the pathway or shooting range of the needle on CT may reduce the air embolism risk.

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Abbreviations

PTNB:

Percutaneous transthoracic needle biopsy

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Yura Ahn, Sang Min Lee, Jooae Choe, Sang Young Oh, Kyung-Hyun Do & Joon Beom Seo

  2. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Hwa Jung Kim

Authors
  1. Yura Ahn
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  2. Sang Min Lee
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  3. Hwa Jung Kim
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  4. Jooae Choe
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  5. Sang Young Oh
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Corresponding author

Correspondence to Sang Min Lee.

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Guarantor

The scientific guarantor of this publication is Sang Min Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Hwa Jung Kim (department of clinical epidemiology and biostatistics, Asan Medical Center) performed statistical analyses.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

3261 percutaneous transthoracic needle biopsies (PTNBs) performed between January 2012 and August 2017 have been reported in a prior study that assessed the learning curve for PTNB (Park R et al, reference 17) which was substantially different work from this study.

Methodology

• retrospective

• case-control

• performed at one institution

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Ahn, Y., Lee, S.M., Kim, H.J. et al. Air embolism in CT-guided transthoracic needle biopsy: emphasis on pulmonary vein injury. Eur Radiol 32, 6800–6811 (2022). https://doi.org/10.1007/s00330-022-09079-6

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  • DOI: https://doi.org/10.1007/s00330-022-09079-6

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