Article Text
Statistics from Altmetric.com
A patient with cirrhosis and hepatocellular carcinoma, on the waiting list for liver transplantation, presented with lung nodule during initial evaluation. A CT-guided core needle lung biopsy under general anaesthesia was performed. Pneumothorax (figure 1) and a large amount of gas within the left ventricle (figure 2) were identified during the procedure. Neurological focal signs (drowsiness, conjugate eye deviation and right hemiparesis) were observed in the anaesthesia-recovery period. A brain CT scan was immediately obtained, showing cerebral air embolism (figure 3). Initial resuscitation and hyperbaric oxygen therapy were performed. Five days later, MRI revealed a massive stroke (figure 4). At 3-month follow-up, the patient recovered motor functions, however, maintained with important cognitive deficits. Systemic air embolism is a rare but potentially life-threatening complication of percutaneous lung biopsy. The incidence ranges from 0.02% to 0.5%.1–3 Coughing during the procedure, cystic or cavitary lesion, positive pressure ventilation and needle-tip placement through a pulmonary vein are the most common predisposing factors. The management involves high-flow 100% oxygen and early hyperbaric oxygen therapy.
CT-guided lung biopsy of the nodule was performed with a 20-gauge needle and the patient in supine position. A small pneumothorax was already seen in this image.
The repeated CT image showed a large amount of gas within the left ventricle.
Axial CT of the brain showed gas locules within the left parietal lobe.
Magnetic resonance image after 5 days revealed the real extension of the embolism. A massive stroke involving both sides of the brain can be seen.
Footnotes
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.