Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2022; 10(16): 5456-5462
Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5456
Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy: A case report
Yi-Wei Li, Can Chen, Ying Xu, Qian-Ping Weng, Shen-Xian Qian
Yi-Wei Li, Qian-Ping Weng, Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Can Chen, Ying Xu, Shen-Xian Qian, Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Author contributions: Qian SX, Li YW, and Chen C conceptualized the case report; Li YW and Xu Y analyzed and interpreted the data; Qian SX, Chen C, and Li YW interpreted CT images; Li YW, Chen C, and Weng QP performed data collection; Li YW, Xu Y, and Weng QP wrote the initial draft and revised the manuscript; Li YW and Qian SX critically revised the manuscript; all authors critically reviewed the manuscript and approved the final version of the manuscript.
Supported by the Science and Technology Development Project of Hangzhou, No. 202004A15.
Informed consent statement: Informed written consent was obtained from the daughter of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shen-Xian Qian, MD, PhD, Chief Doctor, Professor, Senior Researcher, Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 216 Huansha Road, Hangzhou 310006, Zhejiang Province, China. sxqian1028@zju.edu.cn
Received: October 14, 2021
Peer-review started: October 14, 2021
First decision: January 18, 2022
Revised: February 1, 2022
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: June 6, 2022
Processing time: 230 Days and 20.5 Hours
Abstract
BACKGROUND

Computed tomography (CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology, but entails a risk of complications including systematic air embolism (SAE). While SAE is often well tolerated, it can be difficult to treat and may result in rapid mortality in some cases.

CASE SUMMARY

We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe. Shortly following needle extraction, she experienced a mild cough, hemoptysis, rapid-onset unconsciousness, and cardiopulmonary arrest. Cardiopulmonary resuscitation was immediately performed, but the patient died 40 min after the procedure. A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.

CONCLUSION

Although SAE is generally well tolerated and asymptomatic, interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols. In this report, the characteristics, mechanisms, and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.

Keywords: Systematic air embolism, Computed tomography-guided lung biopsy, Bronchovenous fistula, Risk-factors, Emergency intervention, Case report

Core Tip: Systemic air embolism (SAE) is a rare but potentially fatal complication of certain procedures. Although some risk factors and emergency treatments for SAE have been proposed, a proportion of patients nonetheless suffer from catastrophic SAE even if procedures are performed by experienced operators, ultimately experiencing poor outcomes. Lesion localization above the level of the left atrium is a risk factor for SAE following percutaneous lung biopsy. Positive pressure ventilation may exacerbate SAE-related episodes in patients suffering from catastrophic air embolism, particularly in those who required cardiopulmonary resuscitation.