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Ricciardella F, Mannetta G, Caruso V, Cocco G, Mantini C, Piccirilli E, Caulo M, Delli Pizzi A. Air embolism as a rare complication of lung biopsy: A case report. Radiol Case Rep 2024; 19:1547-1551. [PMID: 38317699 PMCID: PMC10839755 DOI: 10.1016/j.radcr.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Lung biopsy is an important interventional radiology procedure allowing the characterization of lesions with suspected malignancy. The most frequent complications are pneumothorax and hemorrhage. Air embolism is a rare but potentially fatal occurrence. In this case report, we present an air embolism after core needle CT-guided biopsy showing CT and MRI features that radiologists should expect in the everyday clinical practice.
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Affiliation(s)
- Federica Ricciardella
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Gianluca Mannetta
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Valentina Caruso
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Cesare Mantini
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Massimo Caulo
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Innovative Technologies in Medicine & Odontoiatry, “G. d'Annunzio” University, Chieti, Italy
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Nakama R, Arai Y, Horii T, Kobayashi T. Computed tomography-guided percutaneous needle biopsy for middle mediastinal tumors with retroaortic paravertebral approach: A case report. Radiol Case Rep 2024; 19:1440-1444. [PMID: 38292803 PMCID: PMC10827543 DOI: 10.1016/j.radcr.2023.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
A 74-year-old man was referred to our hospital for a close examination of a mediastinal mass. Contrast-enhanced CT showed a middle mediastinal tumor. We planned to perform a CT-guided percutaneous needle biopsy of the tumor using a retroaortic paravertebral approach to avoid transpulmonary puncture. A coaxial blunt-tip needle with a side hole was used to create space in the mediastinum and avoid azygos vein injury. After injecting normal saline, a blunt-tip needle was advanced through the space between the aorta and the vertebral body to the anterior surface of the tumor, and tissue was obtained. The patient was discharged the following day with no complications. For percutaneous middle mediastinal tumor biopsy, the retroaortic paravertebral approach may be a safe, effective route.
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Affiliation(s)
- Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Yasunori Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Toshihiro Horii
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Lu H, Yu J, Sun H, Yan S. Acute Coronary Artery Air Embolism Complicating a CT-guided percutaneous lung biopsy: A case report. Heliyon 2024; 10:e27914. [PMID: 38509877 PMCID: PMC10950704 DOI: 10.1016/j.heliyon.2024.e27914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Systemic air embolism is a fatal complication of computed tomography-guided percutaneous lung biopsy. Here, we report a case of acute coronary artery air embolism following computed tomography (CT) guided percutaneous lung biopsy. The patient exhibited cardiac symptoms, and CT showed air density in left ventricle and aorta, indicating air embolism. Trendelenburg positioning and coronary angiography were performed during the treatment, and the patient was discharged without obvious complications.
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Affiliation(s)
- Haotian Lu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Jieqiong Yu
- Department of Emergency, China-Japan Friendship Hospital, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, China
| | - Shengtao Yan
- Department of Emergency, China-Japan Friendship Hospital, China
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Pigaiani N, Barbiero G, Balestro E, Ausania F, McCleskey B, Begni E, Bortolotti F, Brunelli M, De Leo D. Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice? Forensic Sci Med Pathol 2024; 20:199-204. [PMID: 37160632 PMCID: PMC10944409 DOI: 10.1007/s12024-023-00639-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.
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Affiliation(s)
- Nicola Pigaiani
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy.
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA.
| | - Giulio Barbiero
- Unit of Radiology, Department of Medicine, University of Padova, University Hospital, 35128, Padua, Italy
| | - Elisabetta Balestro
- Unit of Respiratory Diseases, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, University Hospital, 35128, Padua, Italy
| | - Francesco Ausania
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Brandi McCleskey
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA
| | - Erica Begni
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Federica Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Matteo Brunelli
- Unit of Pathology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Domenico De Leo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
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Yang Y, Ma J, Peng Z, Zhou X, Du N, Zhang W, Yan Z. Pneumothorax and pulmonary hemorrhage after C-arm cone-beam computed tomography-guided percutaneous transthoracic lung biopsy: incidence, clinical significance, and correlation. BMC Pulm Med 2024; 24:33. [PMID: 38218792 PMCID: PMC10787482 DOI: 10.1186/s12890-023-02822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after percutaneous transthoracic lung biopsy (PTLB) guided by C-arm cone-beam computed tomography (CBCT). Furthermore, this study aimed to examine the relationships between PTX and PH with demographics, clinical characteristics, imaging, and PTLB parameters. METHODS A retrospective analysis was conducted on 192 patients who underwent PTLB at our hospital between January 2019 and October 2022. Incidences of PTX and PH were recorded. PTX was considered clinically significant if treated with chest tube insertion (CTI), and PH if treated with bronchoscopes or endovascular treatments. The various factors on PTX and PH were analyzed using the Chi-squared test and Student t-test. Logistic regression analyses were then used to determine these factors on the correlation to develop PTX and PH. RESULTS PTX occurred in 67/192 cases (34.9%); CTI was required in 5/67 (7.5%). PH occurred in 63/192 cases (32.8%) and none of these cases required bronchoscopes or endovascular treatments. Lesion diameter (ORPTX = 0.822; ORPH = 0.785), presence of pulmonary emphysema (ORPH = 2.148), the number of samples (ORPH = 1.834), the use of gelfoam (ORPTX = 0.474; ORPH = 0.341) and ablation (ORPTX = 2.351; ORPH = 3.443) showed statistically significant correlation to PTX and PH. CONCLUSIONS CBCT-guided PTLB is a safe and effective method for performing lung biopsies. The use of gelfoam has been shown to reduce the occurrence of PTX and PH. However, caution should be exercised when combining radiofrequency ablation with PTLB, as it may increase the risk of PTX and PH.
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Affiliation(s)
- Yanjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhijie Peng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Sun SL, Yang ZJ, Sun HL, Huang ZG, Xu YY, Wang YL, Gao BX, Li CD. Air embolism after CT-guided localization of pulmonary ground-glass nodules. Br J Radiol 2023; 96:20220583. [PMID: 37660366 PMCID: PMC10546455 DOI: 10.1259/bjr.20220583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS). METHODS The data of all patients who received CT-guided localization of GGNs before VATS from May 2020 to October 2021 were retrospectively analyzed. RESULTS A total of 1395 consecutive patients with 1553 GGNs were enrolled. AEs occurred in seven patients (0.5%). In four of the seven patients with AE, the embolism was detected before the patients left the CT table and emergency treatments were carried out. Among them, one patient had chest tightness and unilateral limb dyskinesia, one patient had convulsions and transient loss of consciousness, and two patients had no definite clinical symptoms. After a short-term high-flow oxygen inhalation, the clinical symptoms of two patients with symptomatic AE disappeared and two patients with asymptomatic AE did not show any symptoms. In the remaining three patients with AE, the embolism were detected retrospectively when evaluating the images in the PACS for this study. Fortunately, these three patients never developed clinical symptoms related to AE. All seven patients with AE underwent VATS on the day of localization and all GGNs were successfully removed under the guidance of markers. CONCLUSION The incidence of AE related to CT-guided localization of GGNs was 0.5%, which was significantly higher than expected. Post-localization whole thoracic CT should be performed and observed carefully so as to avoid missed AE and delayed treatment. ADVANCES IN KNOWLEDGE The incidence of AE related to CT-guided localization of GGNs was 0.5%. In order to timely detect AE, whole thoracic CT scan rather than local CT in the lesion area should be performed after localization. A small amount of AE may be missed if the post- localization CT images are not carefully observed.
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Affiliation(s)
- Shi-long Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zeng-jian Yang
- Department of the Second Ward of Respiratory and Critical Care Medicine, Zhucheng People’s Hospital, Shandong Province, China
| | - Hong-liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yan-yan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yu-li Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bao-xiang Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Chuan-dong Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Pan J, Meng D, Chen L, Qu J, Hu J, Dai L. Cerebral air embolism after computed tomography-guided percutaneous transthoracic lung biopsy: a case description. Quant Imaging Med Surg 2023; 13:7398-7403. [PMID: 37869310 PMCID: PMC10585508 DOI: 10.21037/qims-23-216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/22/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Jie Pan
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Danyang Meng
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Liang Chen
- Department of Head and Neck Surgery, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Juan Qu
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jin Hu
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Liju Dai
- Department of Neurology, Affiliated Hospital of Jiaxing University, Jiaxing, China
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Duignan JA, Ryan DT, O'Riordan B, O'Brien A, Healy GM, O'Brien C, Butler M, Keane MP, McCarthy C, Murphy DJ, Dodd JD. Combined autologous blood patch-immediate patient rollover does not reduce the pneumothorax or chest drain rate following CT-guided lung biopsy compared to immediate patient rollover alone. Eur J Radiol 2023; 160:110691. [PMID: 36640713 DOI: 10.1016/j.ejrad.2023.110691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
PUPROSE The purpose of this study was to evaluate a combined autologous blood-patch (ABP)-immediate patient rollover (IPR) technique compared with the IPR technique alone on the incidence of pneumothorax and chest drainage following CT-guided lung biopsy. METHODS In this interventional cohort study of both prospectively and retrospectively acquired data, 652 patients underwent CT-guided lung biopsy. Patient demographics, lesion characteristics and technical biopsy variables including the combined ABP-IPR versus IPR alone were evaluated as predictors of pneumothorax and chest drain rates using regression analysis. RESULTS The combined ABP-IPR technique was performed in 259 (39.7 %) patients whilst 393 (60.3 %) underwent IPR alone. There was no significant difference in pneumothorax rate or chest drains required between the combined ABP-IPR vs IPR groups (p =.08, p =.60 respectively). Predictors of pneumothorax adjusted for the combined ABP-IPR and IPR alone groups included age (p =.02), lesion size (p =.01), location (p =.005), patient position (p =.008), emphysema along the needle track (p =.005) and lesion distance from the pleura (p =.02). Adjusted predictors of chest drain insertion included lesion location (p =.09), patient position (p =.002), bullae crossed (p =.02) and lesion distance from the pleura (p =.02). CONCLUSION The combined ABP-IPR technique does not reduce the pneumothorax or chest drain rate compared to the IPR technique alone. Utilising IPR without an ABP following CT-guided lung biopsy results in similar pneumothorax and chest drain rates while minimising the potential risk of systemic air embolism.
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Affiliation(s)
- John A Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
| | - David T Ryan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Brian O'Riordan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Amy O'Brien
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac O'Brien
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland.
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Ahn Y, Lee SM, Kim HJ, Choe J, Oh SY, Do KH, Seo JB. Air embolism in CT-guided transthoracic needle biopsy: emphasis on pulmonary vein injury. Eur Radiol 2022; 32:6800-6811. [PMID: 36006429 DOI: 10.1007/s00330-022-09079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether pulmonary vein injury is detectable on CT and associated with air embolism after percutaneous transthoracic needle biopsy (PTNB) in a tertiary referral hospital. METHODS Between January 2012 and November 2021, 11,691 consecutive CT-guided PTNBs in 10,685 patients were retrospectively evaluated. Air embolism was identified by reviewing radiologic reports. Pulmonary vein injury was defined as the presence of the pulmonary vein in the needle pathway or shooting range of the cutting needle with the presence of parenchymal hemorrhage. The association between pulmonary vein injury and air embolism was assessed using logistic regression analysis in matched patients with and without air embolism with a ratio of 1:4. RESULTS A total of 27 cases of air embolism (median age, 67 years; range, 48-80 years; 24 men) were found with an incidence of 0.23% (27/11,691). Pulmonary vein injury during the procedures was identifiable on CT in 24 of 27 patients (88.9%), whereas it was 1.9% (2/108) for matched patients without air embolism The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]). In univariable and multivariable analyses, pulmonary vein injury was associated with air embolism (odds ratio, 485.19; 95% confidence interval, 68.67-3428.19, p <.001). CONCLUSION Pulmonary vein injury was detected on CT and was associated with air embolism. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT may reduce air embolism risk. KEY POINTS • Pulmonary vein injury during CT-guided biopsy was identifiable on CT in most of the patients (88.9% [24/27]). • The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]). • Avoiding the distinguishable pulmonary vein along the pathway or shooting range of the needle on CT may reduce the air embolism risk.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Pietersen PI, Kristjansdottir B, Laursen C, M Jørgensen G, Graumann O. Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion – a systematic search of case reports and case series. Acta Radiol Open 2022; 11:20584601221096680. [PMID: 35770135 PMCID: PMC9234839 DOI: 10.1177/20584601221096680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Systemic air embolism is a rare, however potentially fatal, low incidence, complication to CT-guided transthoracic needle biopsy of lung lesions. Purpose The purpose of this review of case reports and series was to pool data about this rare complication and glance for a pattern or similarities in the patients’ initial symptoms and course, as well as the management of the patients in relation to current guidelines. Material and methods PubMed was searched for case reports and case series about systemic air embolisms following CT-guided transthoracic needle biopsy of lung lesions from inception to November 2021. A reviewer screened the results for eligibility and included studies which reported at least two outcomes of interest. Data was extracted by one author and a descriptive analysis was conducted. Results Of 1,136 studies screened, 83 were eligible for inclusion involving 97 patients. The mean age was 64.8±11.7 years and ≈60% of the patients were men. In 15 cases the outcome was fatal, and most of the fatal cases ( n = 12) had cardiac arrest as the primary initial symptom. In addition to conventional oxygen therapy, 34 patients received hyperbaric oxygen therapy, and in 30 cases the physician in charge chose to change the patient from standard supine position to – most often – Trendelenburg position. Conclusion No similarities were found that could lead to more rapid diagnosis or more correct management. The staff should keep systemic air embolisms in mind, when more common complications are ruled out, and consider hyperbaric oxygen therapy in case of suspicion.
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Affiliation(s)
- Pia I Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
| | - Björg Kristjansdottir
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
| | - Christian Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte M Jørgensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
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Larocque N, Brook OR. Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications. Semin Intervent Radiol 2022; 39:218-225. [PMID: 36062222 PMCID: PMC9433161 DOI: 10.1055/s-0042-1751292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications.
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Affiliation(s)
- Natasha Larocque
- Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Olga R. Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Chen Y, Zheng C, Zeng Q, Zhang F, Tu S, Wu Z. Cerebral Air Embolism After Pigtail Catheter Drainage for Pneumothorax: A Case Report and Review of the Literature. Front Surg 2021; 8:743051. [PMID: 34651011 PMCID: PMC8506035 DOI: 10.3389/fsurg.2021.743051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Cerebral air embolism (CAE) is an extremely rare but serious complication of pigtail catheter drainage. The aim of the case report is to review our experience in the diagnosis and treatment for CAE after pigtail catheter drainage. Case presentation: In our study, we report a case of CAE following pigtail catheter insertion for pneumothorax. A 50-year-old man was diagnosed with a pulmonary mass in the right lower lobe. He underwent a right lower lobectomy. Pneumothorax was present after the removal of the chest tube. Pigtail catheter drainage was used in order to treat the pneumothorax, which resulted in convulsions, limb stiffness, and unconsciousness. A brain CT scan was immediately performed and showed multiple low densities in the right occipital lobe, which was diagnosed as CAE. Assisted breathing, antibiotic treatment, and antiepileptic therapy were used and the patient gradually improved and was discharged at 27 days of treatment but the muscle strength of the left limb was weakened. Conclusion: We analyzed and summarized the possible causes of CAE in the literature, and the findings of the case could enhance the vigilance of clinicians.
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Affiliation(s)
- Yi Chen
- Department of Operating Room, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
| | - Chunhui Zheng
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
| | - Qinghui Zeng
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
| | - Fangbiao Zhang
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
| | - Shaosong Tu
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
| | - Zhijun Wu
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, China
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Lin CY, Chang CC, Chu CY, Huang LT, Chung TJ, Liu YS, Yen YT. Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing. Front Med (Lausanne) 2021; 8:650381. [PMID: 34095167 PMCID: PMC8169979 DOI: 10.3389/fmed.2021.650381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Adequate and representative tissue from lung tumor is important in the era of precision medicine. The aim of this study is to identify detailed procedure-related variables and factors influencing diagnostic success and tissue adequacy for molecular testing in CT-guided TTNB. Methods: Consecutive patients undergoing CT-guided TTNB were retrospectively enrolled between January 2013 and May 2020. Multivariate analysis was performed for predictors for diagnostic accuracy and tissue adequacy for molecular testing. Logistic regression was used to identify risk factors for procedure-related complications. Results: A total of 2,556 patients undergoing CT-guided TTNB were enrolled and overall success rate was 91.5% (2,338/2,556). For lung nodules ≤3 cm, predictors for diagnostic success included coaxial needle use [OR = 0.34 (0.16–0.71), p = 0.004], CT scan slice thickness of 2.5 mm [OR = 0.42 (0.15–0.82), p = 0.011] and additional prefire imaging [OR = 0.31 (0.14–0.68), p = 0.004]. For lung tumor >3 cm, ground glass opacity part more than 50% [OR = 7.53 (2.81–20.23), p < 0.001] or presence of obstructive pneumonitis [OR = 2.31 (1.53–3.48), p < 0.001] had higher risk of diagnostic failure. For tissue adequacy, tissue submitted in two cassettes (98.9 vs. 94.9%, p = 0.027) was a positive predictor; while male (5.7 vs. 2.5%, p = 0.032), younger age (56.61 ± 11.64 vs. 65.82 ± 11.98, p < 0.001), and screening for clinical trial (18.5 vs. 0.7%, p < 0.001) were negative predictors. Conclusions: Using a coaxial needle, with thin CT slice thickness (2.5 mm), and obtaining additional prefire imaging improved diagnostic success, while obtaining more than two tissue cores and submitting in two cassettes improved tissue adequacy for molecular testing.
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Affiliation(s)
- Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Yao Chu
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Jung Chung
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan.,Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
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