A retrospective analysis of the risk factors associated with systemic air embolism following percutaneous lung biopsy

Abstract

In the present study, the risk factors for systemic air embolism as a complication of percutaneous CT-guided lung biopsy were explored. Data from 2,026 percutaneous CT-guided lung biopsy procedures were retrospectively analyzed. All cases were divided into a concurrent air embolism group and a control group, depending on whether air embolism occurred during the puncture process. A systemic air embolism was confirmed when CT values <-200 Hounsfield units were observed in two sequential images. A total of 19 cases (0.9%) of air embolism were detected among the 2,026 patients subjected to percutaneous CT-guided lung biopsy procedures. The most frequently detected embolism site was the left ventricle (89.5%). Only 3 cases (15.8%) were accompanied by obvious clinical symptoms. The results indicated that a puncture location above the level of the left atrium and coughing during the procedure significantly altered the likelihood of embolism developing (P=0.002 and P=0.014 vs. control, respectively). In conclusion, a puncture lesion above the level of the left atrium and coughing during the procedure may be risk factors for air embolism development.

Keywords: X-ray computed; air embolism; image-guided biopsy; lung; risk factors; tomography.

Figure 1.

CT images of case 5. After lung biopsy a small amount of air was identified in the left ventricle and aorta (white arrows) and in the cerebral blood vessels (yellow arrow). (A) Before percutaneous lung biopsy, the patient was placed in a left-lateral position. The relative position of the puncture directed at the lesion without a trocar was higher than the level of the left atrium. The patient coughed during the puncture and a chest CT obtained immediately after percutaneous lung biopsy indicated air embolism in (B) the left ventricle, (C) the descending aorta and (D) the aortic arch. Routine CT scan of the brain was performed immediately after air embolism was found by chest CT examination. (E) Air embolism was also detected in the patient's cerebral blood vessels (yellow arrow). Thirty minutes after the brain CT examination, the patient's symptoms disappeared, at this time, (F) a second brain CT scan revealed that the air embolism in the cerebrovascular tissue had dissipated.

Figure 2.

CT scans of case 10. (A) Before percutaneous lung biopsy, the patient was placed in a supine position, the relative puncture location was higher than the level of the left atrium and air pockets were observed inside the lesion. The patient coughed after the second puncture. Images from the chest CT immediately after percutaneous lung biopsy show that an air embolism was observed in (B) the right coronary artery and (C) the distal branch of the right coronary artery and that (D) a small amount of air was observed in the left ventricle (yellow arrow).