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Meta-Analysis
. 2023 May 31;29(3):478-491.
doi: 10.4274/dir.2022.221187. Epub 2023 Mar 20.

Risk factors for air embolism following computed tomography-guided percutaneous transthoracic needle biopsy: a systematic review and meta-analysis

Hanfei Zhang  1 , Shan Wang  1 , Feiyang Zhong  1 , Meiyan Liao  1
Affiliations
Meta-Analysis

Risk factors for air embolism following computed tomography-guided percutaneous transthoracic needle biopsy: a systematic review and meta-analysis

Hanfei Zhang et al. Diagn Interv Radiol. .

Abstract

To quantitatively analyze the risk factors for air embolism following computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and qualitatively review their characteristics. The databases of PubMed, Embase, Web of Science, Wanfang Data, VIP information, and China National Knowledge Infrastructure were searched on January 4, 2021, for studies reporting the occurrence of air embolisms following CT-guided PTNB. After study selection, data extraction, and quality assessment, the characteristics of the included cases were qualitatively and quantitatively analyzed. A total of 154 cases of air embolism following CT-guided PTNB were reported. The reported incidence was 0.06% to 4.80%, and 35 (22.73%) patients were asymptomatic. An unconscious or unresponsive state was the most common symptom (29.87%). Air was most commonly found in the left ventricle (44.81%), and 104 (67.53%) patients recovered without sequelae. Air location (P < 0.001), emphysema (P = 0.061), and cough (P = 0.076) were associated with clinical symptoms. Air location (P = 0.015) and symptoms (P < 0.001) were significantly associated with prognosis. Lesion location [odds ratio (OR): 1.85, P = 0.017], lesion subtype (OR: 3.78, P = 0.01), pneumothorax (OR: 2.16, P = 0.003), hemorrhage (OR: 3.20, P < 0.001), and lesions located above the left atrium (OR: 4.35, P = 0.042) were significant risk factors for air embolism. Based on the current evidence, a subsolid lesion, being located in the lower lobe, the presence of pneumothorax or hemorrhage, and lesions located above the left atrium were significant risk factors for air embolism.

Keywords: risk factor; Air embolism; CT-guided PTNB; meta-analysis.

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Conflict of interest statement

Conflict of interest disclosure

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram of the study selection process. CT, computed tomography.
Figure 2
Figure 2
Forest plots of the relationship between lesion location (upper and middle lobe vs. lower lobe) and air embolism following computed tomography-guided percutaneous transthoracic lung needle biopsy. CI, confidence interval; OR, odds ratio.
Figure 3
Figure 3
Forest plots of the relationship between lesion subtype (solid vs. subsolid) and air embolism following computed tomography-guided percutaneous transthoracic lung needle biopsy. CI, confidence interval; OR, odds ratio.
Figure 4
Figure 4
Forest plots of the relationship between pneumothorax and air embolism following computed tomography-guided percutaneous transthoracic lung needle biopsy. CI, confidence interval; OR, odds ratio.
Figure 5
Figure 5
Forest plots of the relationship between hemorrhage and air embolism following computed tomography-guided percutaneous transthoracic lung needle biopsy. CI, confidence interval; OR, odds ratio.
Figure 6
Figure 6
Forest plots of lesion location above the level of the left atrium. CI, confidence interval; OR, odds ratio.
See this image and copyright information in PMC

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