Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5456
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
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.
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.
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.
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.