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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Cerebral air embolism complicating transbronchial lung biopsy: A case report
Vladimir Herout, Kristian Brat, Svatopluk Richter, Ivan Cundrle Jr
Vladimir Herout, Kristian Brat, Department of Respiratory Diseases, University Hospital Brno, Brno 62500, Czech Republic
Vladimir Herout, Kristian Brat, Department of Respiratory Diseases, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Kristian Brat, Ivan Cundrle Jr, International Clinical Research Center, Brno 60200, Czech Republic
Svatopluk Richter, Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno 62500, Czech Republic
Ivan Cundrle Jr, Department of Anesthesiology and Intensive Care, St. Anne's University Hospital, Brno 60200, Czech Republic
Ivan Cundrle Jr, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, Brno 60200, Czech Republic
Author contributions: Herout V was patient’s bronchologist, reviewed the literature and contributed to manuscript drafting; Richter S analyzed and interpreted the imaging findings; Cundrle Jr I reviewed the literature and drafted the manuscript; Brat K was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by The publication has been supported by Ministry of Health of the Czech Republic, No. MH CZ-DRO FNBr 65269705; and The Czech Pneumological and Phthisiological Society (open access publication fee grant).
Informed consent statement: Written informed consent was obtained from the patient as part of consent with bronchoscopy procedure (including publication of his anonymized scientific data).
Conflict-of-interest statement: The authors declare no conflicts of interest in relation to the presented case report.
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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kristian Brat, MD, PhD, Assistant Professor, Senior Scientist, Department of Respiratory Diseases, University Hospital Brno, Jihlavska 20, Brno 62500, Czech Republic. kristian.brat@seznam.cz
Received: June 9, 2021
Peer-review started: June 11, 2021
First decision: June 25, 2021
Revised: July 2, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: November 16, 2021
BACKGROUND
In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy (TBLB). Only a few cases of this rare complication were described previously. Every bronchologist should recognize this severe adverse event. Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.
CASE SUMMARY
In this case report we describe an extremely rare case of cerebral air embolism following TBLB. Only a few cases of this rare complication were described previously. Our patient had an incidental finding of lung tumour and pulmonary emphysema. Cerebral air embolism developed during bronchoscopy procedure, immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia. Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later. Cerebral air embolism is an extremely rare complication of TBLB. This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the post-intervention period since early recognition, diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.
CONCLUSION
Within this report, we conclude that air/gas embolism is an extremely rare complication after TBLB, which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the post-intervention period after bronchoscopy. The current gold standard for diagnosis is computed tomography scan of the head. After recognition of this complication we suggest immediate hyperbaric oxygen therapy, if available.
Core Tip: Cerebral air embolism is an extremely rare complication of transbronchial lung biopsy. This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the post-intervention period since early recognition, diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.
