Systemic Air Embolism Following CT-Guided Transthoracic Lung Biopsy: A Rare and Life-Threatening Complication
Poster #: 034
Session/Time: A
Author:
Nina Li, MS
Mentor:
Trenton Taros, MD
Research Type: Case Report
Abstract
INTRODUCTION:
CT-guided transthoracic lung biopsy is a key diagnostic procedure in evaluating lesions suspicious for malignancy. While pneumothorax and hemorrhage are well known complications, systemic air embolism (SAE) is a rare but potentially fatal occurrence. We present a case of SAE following core needle biopsy of a right lung lesion, highlighting imaging findings and multidisciplinary management.
CASE INFORMATION:
A 53-year-old female with a history of left lung adenocarcinoma status post lobectomy, presented for biopsy of an enlarging right middle lobe lung mass measuring 5.3 cm x 1.2 cm. Under general anesthesia, she underwent CT-guided core needle biopsy with four 20G core samples obtained. Immediately post-procedure, the patient developed ST elevations and acute hypotension. CT of the chest and head revealed extensive air embolism involving both cardiac chambers, the aortic root, right cerebral hemisphere, coronary arteries, hepatic vasculature, and a concurrent right pneumothorax. The patient was placed into a severe Trendelenburg position and transferred to the vascular interventional suite for emergent aspiration thrombectomy and chest tube placement. She subsequently underwent hyperbaric oxygen chamber therapy and was admitted to the ICU under sedation. Patient was discharged home on hospital day 6 in stable condition with minimal residual effects noted at most recent follow up.
DISCUSSION:
Systemic air embolism can occur when air enters the pulmonary venous system and transits into the systemic circulation, resulting in myocardial infarction, cerebral ischemia, or other forms of end-organ damage. In this case, it is suspected to have occurred via a bronchial-pulmonary vein communication under positive pressure ventilation. Risk factors for SAE include air-filled lesions (cysts/cavities), larger gauge biopsy needles, positive pressure ventilation, patient coughing, and lesion positioning above the level of the left atrium.
CONCLUSION:
This report presents rare emergent imaging of SAE occurring immediately after lung biopsy. With current literature often showing SAE to be fatal, this case underscores the importance of rapid recognition and multidisciplinary management to prevent lasting sequelae, even with the extent of embolized air shown.
CT-guided transthoracic lung biopsy is a key diagnostic procedure in evaluating lesions suspicious for malignancy. While pneumothorax and hemorrhage are well known complications, systemic air embolism (SAE) is a rare but potentially fatal occurrence. We present a case of SAE following core needle biopsy of a right lung lesion, highlighting imaging findings and multidisciplinary management.
CASE INFORMATION:
A 53-year-old female with a history of left lung adenocarcinoma status post lobectomy, presented for biopsy of an enlarging right middle lobe lung mass measuring 5.3 cm x 1.2 cm. Under general anesthesia, she underwent CT-guided core needle biopsy with four 20G core samples obtained. Immediately post-procedure, the patient developed ST elevations and acute hypotension. CT of the chest and head revealed extensive air embolism involving both cardiac chambers, the aortic root, right cerebral hemisphere, coronary arteries, hepatic vasculature, and a concurrent right pneumothorax. The patient was placed into a severe Trendelenburg position and transferred to the vascular interventional suite for emergent aspiration thrombectomy and chest tube placement. She subsequently underwent hyperbaric oxygen chamber therapy and was admitted to the ICU under sedation. Patient was discharged home on hospital day 6 in stable condition with minimal residual effects noted at most recent follow up.
DISCUSSION:
Systemic air embolism can occur when air enters the pulmonary venous system and transits into the systemic circulation, resulting in myocardial infarction, cerebral ischemia, or other forms of end-organ damage. In this case, it is suspected to have occurred via a bronchial-pulmonary vein communication under positive pressure ventilation. Risk factors for SAE include air-filled lesions (cysts/cavities), larger gauge biopsy needles, positive pressure ventilation, patient coughing, and lesion positioning above the level of the left atrium.
CONCLUSION:
This report presents rare emergent imaging of SAE occurring immediately after lung biopsy. With current literature often showing SAE to be fatal, this case underscores the importance of rapid recognition and multidisciplinary management to prevent lasting sequelae, even with the extent of embolized air shown.