A 72-year-old male was referred to our hospital because of a lung nodule. Computed tomography (CT) showed a lung nodule in the right-lower lobe (Fig. 1A). A CT-guided percutaneous lung biopsy was planned. Figure 1. View largeDownload slide Chest CT (A) demonstrated a pulmonary nodule (2.5 cm in size) in contact with the right-upper lobe was found in the right-lower lobe. (B) Chest CT showed the needle penetrated the pulmonary vein (arrowhead) which existed behind the pulmonary nodule. Air existed in the pulmonary vein (arrow). (C) The CT image showed a large amount of air within the left atrium (arrow). Figure 1. View largeDownload slide Chest CT (A) demonstrated a pulmonary nodule (2.5 cm in size) in contact with the right-upper lobe was found in the right-lower lobe. (B) Chest CT showed the needle penetrated the pulmonary vein (arrowhead) which existed behind the pulmonary nodule. Air existed in the pulmonary vein (arrow). (C) The CT image showed a large amount of air within the left atrium (arrow). The procedure was performed by an experienced radiologist; the instrument was a coaxial 17 gauge introducer with an 18 gauge core biopsy needle (BARD MISSION Disposable Core Biopsy Instrument, C. R. Bard, Inc., NJ). The patient was instructed to hold his breath during puncture. Depending on the depth of the inspiration, the lesion moved behind the ribs or another lung lobe frequently overlapped the puncture route, so the radiologist planned oblique puncture using CT fluoroscopy, the function to create and display images in real time, but it was difficult to hit the lesion. After several attempts, the patient described chest pain and blood pressure was transiently decreased. CT images revealed a large amount of air flowing into the left atrium from the pulmonary vein (Fig. 1C). Two hours after the procedure, he complained of left homonymous hemianopsia. Head CT showed air in the right-occipital lobe, and brain diffusion-weighted image (DWI) of magnetic resonance imaging (MRI) detected early ischemic lesions in the right-occipital lobe (Fig. 2). A follow-up CT after 100% oxygen treatment and edaravone administration showed complete resolution of cerebral embolism and left homonymous hemianopsia began to recover. Figure 2. View largeDownload slide (A) Axial brain CT showed gas within the right-occipital lobe. (B–D) DWI of MRI detected early ischemic lesions in the right-occipital lobe (arrowhead). Figure 2. View largeDownload slide (A) Axial brain CT showed gas within the right-occipital lobe. (B–D) DWI of MRI detected early ischemic lesions in the right-occipital lobe (arrowhead). The air embolism is rare complication (0.02–0.07%). Some factors are considered contributors: cough, a cystic or cavitary lesion and vasculitis. In our case, the patient has no risk factors. When reviewing the CT during the procedure retrospectively, it turned out that the needle penetrated the pulmonary vein which existed behind the lung nodule (Fig. 1B). We must pay attention to pulmonary veins near nodule during the procedure of a CT-guided percutaneous lung biopsy. Conflict of interest statement The authors declare no conflict of interest associated with this paper. Authors’ contributions T.S., Y.A. and T.N. are the attending physicians for this patient. T.S. and Y.A. wrote the initial draft of the manuscript. J.S. performed CT-guided lung biopsy. The final version of the manuscript was approved by all authors. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Japanese Journal of Clinical Oncology – Oxford University Press
Published: May 18, 2018
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