Systemic arterial air embolism following computed tomography (CT)-guided percutaneous lung biopsy: Case series and review of underlying risk factors, treatment and preventive strategies

TL;DR

This paper reports two cases of rare but serious air embolism after lung biopsies and discusses ways to prevent and manage this complication.

Contribution

The paper presents two new case reports and provides insights into risk factors and preventive strategies for systemic arterial air embolism.

Findings

Two patients developed neurological deficits due to cerebral air embolism during lung biopsies.

Neurological symptoms improved with oxygen and positioning, and both cases confirmed lung cancer.

Risk mitigation includes patient positioning and minimizing pressure gradients during the procedure.

Abstract

Systemic arterial air embolism is an uncommon but potentially fatal complication of CT-guided transthoracic lung biopsy. Although rare, it carries significant morbidity due to cerebral and coronary ischaemia.

We report two cases of systemic arterial air embolism occurring during CT-guided percutaneous lung biopsies. Both patients developed acute neurological deficits immediately following the procedure, attributed to cerebral air embolism. Imaging confirmed the presence of intracranial air in subarachnoid spaces. Neurological symptoms improved with supportive management, including oxygen administration and positioning. Histopathology in both cases revealed pulmonary adenocarcinoma.

These cases highlight the importance of prompt recognition and appropriate management of systemic air embolism. Risk mitigation strategies include careful patient positioning, minimisation of intrapulmonary pressure gradients, and maintenance of needle occlusion. Although rare, this complication must be anticipated by interventionalists and managed promptly to avoid permanent neurological damage.

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