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Ann Thorac Surg 2009;87:1622. doi:10.1016/j.athoracsur.2008.08.035
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Arterial Air Embolism: A Rare but Life-Threatening Complication of Percutaneous Needle Biopsy of the Lung

Yoshinori Ishikawa, MDa,b, Haruhisa Matsuguma, MDa,*, Rie Nakahara, MDa, Akiko Ui, MDa, Haruko Suzuki, MDa,b, Kohei Yokoi, MDa,b

a Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
b Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

* Address correspondence to Dr Matsuguma, Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan (Email: hmatsugu{at}tcc.pref.tochigi.jp).

A 51-year-old man was admitted to our hospital for examination of a nodule on chest roentgenograms. For pathologic diagnosis, a transthoracic needle biopsy of the nodule was performed with computed tomographic, fluoroscopic guidance using an automatic cutting needle (Monopty, 16 gauge; Bard Radiology, Covington, GA). The patient was positioned in a right lateral decubitus position. Immediately after the procedure, the patient coughed up approximately 1 to 2 tablespoons of bloody sputa and soon became unresponsive, showing upward gaze fixation and mild right hemiparesis. To exclude tension pneumothorax, computed tomographic scans were immediately obtained, which disclosed an air-fluid level in the descending aorta (Fig 1). Subsequent brain computed tomographic scans also demonstrated air emboli of the cerebral vessels in the left parietal sulci (Fig 2). The patient's consciousness began to clear approximately 30 minutes after the incident, and he was transferred to another hospital to receive hyperbaric oxygen therapy. The patient recovered fully without any signs of neurologic damage and underwent a left upper lobectomy of the lung for the metastatic lung tumor.


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  		Fig 1.
 

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  		Fig 2.
 
Air embolism is a rare, fatal complication of percutaneous needle biopsy. The frequency of air embolism due to this procedure is reported to be 0.02%, and as little as 0.5 mL of air could be sufficient to induce coronary ischemia and fatal arrhythmia [1]. When the patient had a fit of coughing during the needle biopsy, continuous high intrathoracic pressure might have pushed a large amount of air into the pulmonary vein. Although air embolism is a very rare complication of percutaneous needle biopsy, physicians should be aware of its occurrence and significance.


   References
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 References
 

  1. Klein JS, Zarka MA. Transthoracic needle biopsy Radiol Clin North Am 2000;38:235-265.[Medline]



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