Air embolism after CT-guided percutaneous lung biopsy

Air embolism after CT-guided percutaneous lung biopsy 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: journals.permissions@oup.com. 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) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Japanese Journal of Clinical Oncology Oxford University Press

Air embolism after CT-guided percutaneous lung biopsy

Loading next page...
 
/lp/ou_press/air-embolism-after-ct-guided-percutaneous-lung-biopsy-rUGLW7Qd3O
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
0368-2811
eISSN
1465-3621
D.O.I.
10.1093/jjco/hyy072
Publisher site
See Article on Publisher Site

Abstract

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: journals.permissions@oup.com. 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)

Journal

Japanese Journal of Clinical OncologyOxford University Press

Published: May 18, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off