Influenceable and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique-Case Report, Systematic Literature Review, and a Technical Note

Abstract

Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influenceable or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemostatic valve.

Figure 1

CT image obtained during lung biopsy with the patient in left lateral position and the tip of the guiding needle in the wall of a large cavitary lesion of the right upper lobe.

Figure 2

CT image of the brain after lung biopsy with signs of cerebral air embolism, typically visible as subcortical serpentiform formations with negative Hounsfield units.

Figure 3

Combination of a coaxial biopsy guiding needle and a hemostatic valve for percutaneous lung biopsy. The 10 cm guiding needle connected with the hemostatic valve and closed with the inner cannula of the 13 cm device measures as much and can be handled according to the corresponding 13 cm device.

Figure 4

CT image during lung biopsy with guiding needle combined with hemostatic valve as described (under intubation anaesthesia at the explicit request of the patient, with venous port system visible in the edge region).