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Images in Thorax
Cerebral air embolism during CT-guided lung biopsy
  1. Rafael Dahmer Rocha,
  2. André Arantes Azevedo,
  3. Priscila Mina Falsarella,
  4. Antônio Rahal Jr,
  5. Rodrigo Gobbo Garcia
  1. Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Rafael Dahmer Rocha, Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, 627/701 - Morumbi, São Paulo - São Paulo 05652-900, Brazil; rafaeldrocha{at}

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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.

Figure 1

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.

Figure 2

The repeated CT image showed a large amount of gas within the left ventricle.

Figure 3

Axial CT of the brain showed gas locules within the left parietal lobe.

Figure 4

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.


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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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