Systemic air embolism causing acute stroke and myocardial infarction after percutaneous transthoracic lung biopsy - a case report

Abstract

The air embolism in this case was likely to have been caused by positioning the patient in a prone position, which was associated with the lesion to be biopsied being at a maximum height over the left atrium. Due to the resulting negative pressure, air entered through a fistula that formed between the airspace and the pulmonary vein. The air could have been trapped in the left atrium by positioning the patient in left lateral position. The event itself could have been prevented by positioning the patient in an ipsilateral dependent position during the biopsy. In addition to hyperbaric oxygen therapy, the preferred treatment options are positioning maneuvers, administration of pure oxygen, and heparinization.

Keywords: Air embolism; Intensive care; Myocardial infarction; Stroke; Transthoracic biopsy.

Fig. 1

Pulmonary venous pressures depending on the position of the lesion in relation to the left atrium. If the lesion is located below the level of the atrium, the pulmonary venous pressure at this location is the existing pressure in the left ventricle plus the hydrostatic pressure over the lesion to be biopsied (“T”), defined as the distance from the center of the left atrium to the lesion, marked “A” in the figure. If a pulmonary vein is injured, bleeding occurs here. If the lesion is located above the level of the atrium, the pulmonary venous pressure at this location is the existing pressure in the left atrium minus the hydrostatic pressure below the lesion to be biopsied, defined as the distance from the center of the left atrium to the lesion, marked “B” in the figure. If a pulmonary vein is injured, air enters the pulmonary vein due to the lower viscosity of air compared with blood. LV: Left ventricle; RV: right ventricle; RA: right atrium