Systemic vascular air embolus following CT-guided transthoracic needle biopsy: a potentially fatal complication

Abstract

Following an uncomplicated CT-guided transthoracic biopsy, a patient becomes unconscious and subsequently dies despite immediate cardiac resuscitation. The patient felt well during the procedure but started complaining about dizziness and chest pain when he sat up. When he again was put in a supine position, cardiac arrest was noted. A CT scan performed when the symptoms initiated was afterwards rigorously reviewed by the team and revealed air located in the left ventricle, aorta and right coronary artery.We present a rare but potentially lethal complication following CT-guided transthoracic needle biopsy-systemic vascular air embolus. Knowledge and evidence about the complication are sparse because of low incidence and varying presentation. However, immediate initiation of treatment can save a life, and awareness of the complication is therefore crucial.

Keywords: cancer intervention; lung cancer (oncology); radiology (diagnostics).

Figure 1

CT scan showing the three nodules in the right upper lobe, right lower lobe and left lower lobe (prior to growth).

Figure 2

CT scan of the nodule in the left lower lobe; at the time of referral, the nodule size was 30 mm.

Figure 3

Positron Emission Tomography (PET)-CT shows increased Fluorodeoxyglucose (FDG) uptake in the nodule; the area is approximately 10 mm.

Figure 4

The CT scan performed immediately after the patient loses consciousness. The images reveal air in the left ventricle, aorta and right coronary artery.