Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy

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Abstract

A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.

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Most cited references 9

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Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution.

Hiroyasu Fujiwara, Hideo Gobara, Toshihiro Iguchi … (2007)

Systemic air embolism is recognized as a potentially fatal but extremely rare complication following percutaneous transthoracic needle biopsy. However, its incidence might be underestimated by missing systemic air in patients without cardiac or cerebral symptoms. This study was based on four cases (one man and three women; age range, 54 to 75 years) of systemic air embolism complicating CT scan-guided transthoracic needle biopsy, which were encountered among 1,010 procedures performed at our institution from April 1999 to December 2006. The target lesion was a lung tumor in three patients, and a mediastinal tumor in one patient. The procedure was performed percutaneously under CT scan-fluoroscopic guidance by using a coaxial biopsy needle system. In all four patients, a specimen was successfully obtained from the lesions. During or immediately after the procedure, all patients experienced paroxysms of coughing. In three patients without cardiac or cerebral symptoms, the presence of systemic air was confirmed on postprocedural CT scan images; it was resolved without causing morbidity after the immediate therapy. The presence of systemic air was missed in one initially asymptomatic patient, resulting in a subsequent neurologic deficit. Systemic air embolism following CT scan-guided transthoracic needle biopsy was encountered more frequently than would be expected. The considerable attention we gave to this complication enabled us to recognize it in patients without cardiac or cerebral symptoms. No sequelae were observed in the three patients in whom systemic air embolism was detected, and the therapy was initiated immediately, whereas missing systemic air led to cerebral embolism in one patient in our four cases.

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Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen.

John Mehran, André D Beaulieu, C Wherrett (2001)

To describe a clinical scenario consistent with the diagnosis of cerebral arterial gas embolism (CAGE) acquired during an outpatient bronchoscopy. Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for bronchogenic carcinoma three months earlier. During the direct insufflation of oxygen into the right middle lobe bronchus, the patient became unresponsive and developed subcutaneous emphysema. Immediately, an endotracheal tube and bilateral chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to pain. Later, in the intensive care unit, he exhibited seizure activity requiring anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of barotrauma, and an abnormal electroencephalogram. Fifty-two hours after the event, he was treated for presumed CAGE with hyperbaric oxygen using a modified United States Navy Table 6. Twelve hours later he had regained consciousness and was extubated. He underwent two more hyperbaric treatments and was discharged from hospital one week after the event, fully recovered. A patient with presumed CAGE made a complete recovery following treatment with hyperbaric oxygen therapy even though it was initiated after a significant time delay.

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Complications of percutaneous transthoracic needle aspiration biopsy.

W Sinner (1976)

After 5,300 percutaneous transthoracic needle aspiration biopsy procedures in 2,726 patients pneumothorax occurred in 27.2 per cent of the patients. Only 7.7 per cent required exsufflation or drainage. The factors influencing the relative frequency and the severity of pneumothorax are discussed. Bleeding around the punctured lesions was found in 11 per cent, and hemoptysis in 2 per cent but were of no clinical importance. In one case evidence of needle track implantation was found. The theoretical and practical importance of tumour cell spread and spread of infection through the needle track is discussed. No air embolism or mortality occurred.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Radiol

Journal ID (publisher-id): KJR

Title: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

ISSN (Print): 1229-6929

ISSN (Electronic): 2005-8330

Publication date (Print): Jan-Feb 2009

Publication date (Electronic): 05 February 2009

Volume: 10

Issue: 1

Pages: 81-84

Affiliations

[1 ]Department of Internal Medicine, Dong-A University College of Medicine, Busan 602-715, Korea.

[2 ]Department of Radiology, Dong-A University College of Medicine, Busan 602-715, Korea.

[3 ]Department of Internal Medicine, Busan National University College of Medicine, Busan 602-739, Korea.

Author notes

Address reprint requests to: Choonhee Son, MD, Department of Internal Medicine, Dong-A University College of Medicine, 3-Ga Dongdaeshindong, Seo-gu, Busan 602-715, Korea. Tel. (8251) 242-5852, Fax. (8251) 240-2874, son30243@ 123456hanmail.net

Article

DOI: 10.3348/kjr.2009.10.1.81

PMC ID: 2647167

PubMed ID: 19182507

SO-VID: 40fbed2f-48a8-4908-ab1c-bc0d772ea620

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy

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Abstract

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Most cited references 9

Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution.

Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen.

Complications of percutaneous transthoracic needle aspiration biopsy.

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