A 71-year-old man presented with cough and sputum for 12 months. Chest radiography showed a homogeneous opacity in the right lower lobe. Computed tomography (CT) showed a nodular opacity, 2 cm in diameter, in the posterior segment of the right lower lobe. Mild emphysematous changes were also seen. With the patient in a prone position, a 19-gauge 7.8-cm introducer was placed in the lesion during a single inspiratory breath-hold. A coaxial 20-gauge automated needle was inserted through the introducer using a biopsy gun. Although the patient did not complain of any symptoms, postbiopsy CT showed air in the left ventricle and ascending aorta. After 5 h of bed rest, we found weakness in his left lower extremity. He was transferred to a hyperbaric oxygen chamber and recovered the next day. Air embolism is a rare, potentially fatal complication of percutaneous lung biopsy. Although the true effect of hyperbaric oxygen therapy is controversial, knowledge regarding the prompt management of such cases may help radiologists who perform this procedure.
Air embolism CT-guided needle biopsy Lung
This is a preview of subscription content, log in to check access.
Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006;59:60–64.PubMedCrossRefGoogle Scholar
Dutka AJ. A review of the pathophysiologic and potential application of experimental therapies for cerebral ischemia to the treatment of the cerebral arterial gas embolism. Undersea Biomed Res 1985;12:403–421.PubMedGoogle Scholar
Arnold BW, Zwiebel WJ. Percutaneous transthoracic needle biopsy complicated by air embolism. AJR Am J Roentgenol 2002;178:1400–1402.PubMedGoogle Scholar
Feldmeier JJ. Hyperbaric oxygen 2003: indications and results. In: The hyperbaric oxygen therapy committee report. Kensington, MD: Undersea and Hyperbaric Medical Society; 2003.Google Scholar
Lattin G Jr, O’Brien W Sr. Massive systemic air embolism treated with hyperbaric oxygen therapy following CT-guided transthoracic needle biopsy of a pulmonary nodule. J Vasc Interv Radiol 2006;17:1355–1358.PubMedCrossRefGoogle Scholar
Ashizawa K, Watanabe H, Morooka H, Hayashi K. Hyperbaric oxygen therapy for air embolism complicating CT-guided needle biopsy of the lung. AJR Am J Roentgenol 2004;182:1606–1607.PubMedGoogle Scholar
Worth ER, Burton JR, Landreneau RJ, Eggers GW Jr, Curtis JJ. Left arterial air embolism during intraoperative needle biopsy of a deep pulmonary lesion. Anesthesiology 1990;73:342–345.PubMedCrossRefGoogle Scholar
Hiraki T, Fujiwara H, Sakurai J, Iguchi T, Gobara H, Tajiri N, et al. Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy. Chest 2007;132:684–690.PubMedCrossRefGoogle Scholar
Khalil A, Pregent H, Parrot A, Carette M. Systemic air embolism complicating percutaneous transthoracic needle biopsy. AJR Am J Roentgenol 2006;187:W242–W243.PubMedCrossRefGoogle Scholar
Mansour A, Abdel Raouf S, Qandeel M, Swaidan M. Acute coronary artery air embolism following CT-guided lung biopsy. Cardiovasc Intervent Radiol 2005;28:131–134.PubMedCrossRefGoogle Scholar
Chakravarti R, Singh V, Isaac R, John MJ. Fatal paradoxical pulmonary air embolism complicating percutaneous computed tomography-guided needle biopsy of the lung. Aust Radiol 2004;48:204–206.CrossRefGoogle Scholar