Downloaded from http://thorax.bmj.com/ on December 10, 2015 - Published by group.bmj.com
Chest clinic
IMAGES IN THORAX
Cerebral air embolism during CT-guided lung biopsy Rafael Dahmer Rocha, André Arantes Azevedo, Priscila Mina Falsarella, Antônio Rahal Jr, Rodrigo Gobbo Garcia Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, São Paulo, São Paulo, Brazil Correspondence to Dr Rafael Dahmer Rocha, Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, 627/701 - Morumbi, São Paulo - São Paulo 05652900, Brazil; [email protected]
A patient with cirrhosis and hepatocellular carcinoma, on the waiting list for liver transplantation, presented with lung nodule during initial evaluation. A CT-guided core needle lung biopsy under general anaesthesia was performed. Pneumothorax (figure 1) and a large amount of gas within the left ventricle (figure 2) were identified during the procedure. Neurological focal signs (drowsiness,
conjugate eye deviation and right hemiparesis) were observed in the anaesthesia-recovery period. A brain CT scan was immediately obtained,
Chest clinic
Received 21 April 2015 Accepted 14 May 2015 Published Online First 29 May 2015
Figure 1 CT-guided lung biopsy of the nodule was performed with a 20-gauge needle and the patient in supine position. A small pneumothorax was already seen in this image.
To cite: Rocha RD, Azevedo AA, Falsarella PM, et al. Thorax 2015;70:1099–1100.
Figure 2 The repeated CT image showed a large amount of gas within the left ventricle.
Figure 3 Axial CT of the brain showed gas locules within the left parietal lobe.
Figure 4 Magnetic resonance image after 5 days revealed the real extension of the embolism. A massive stroke involving both sides of the brain can be seen.
Rocha RD, et al. Thorax 2015;70:1099–1100. doi:10.1136/thoraxjnl-2015-207205
1099
Downloaded from http://thorax.bmj.com/ on December 10, 2015 - Published by group.bmj.com
Chest clinic Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed.
REFERENCES 1
2
3
Ishii H, Hiraki T, Gobara H, et al. Risk factors for systemic air embolism as a complication of percutanenous CT-guided lung biopsy: multicenter case-control study. Cardiovasc Intervent Radiol 2014;37:1312–20. Freund MC, Petersen J, Goder KC, et al. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulm Med 2012;12:2. Hare SS, Gupta A, Gonçalves ATC, et al. Systemic arterial air embolism after percutaneous lung biopsy. Clin Radiol 2011;66:589–96.
Chest clinic
showing cerebral air embolism (figure 3). Initial resuscitation and hyperbaric oxygen therapy were performed. Five days later, MRI revealed a massive stroke (figure 4). At 3-month follow-up, the patient recovered motor functions, however, maintained with important cognitive deficits. Systemic air embolism is a rare but potentially life-threatening complication of percutaneous lung biopsy. The incidence ranges from 0.02% to 0.5%.1–3 Coughing during the procedure, cystic or cavitary lesion, positive pressure ventilation and needle-tip placement through a pulmonary vein are the most common predisposing factors. The management involves high-flow 100% oxygen and early hyperbaric oxygen therapy.
1100
Rocha RD, et al. Thorax 2015;70:1099–1100. doi:10.1136/thoraxjnl-2015-207205
Downloaded from http://thorax.bmj.com/ on December 10, 2015 - Published by group.bmj.com
Cerebral air embolism during CT-guided lung biopsy Rafael Dahmer Rocha, André Arantes Azevedo, Priscila Mina Falsarella, Antônio Rahal, Jr and Rodrigo Gobbo Garcia Thorax 2015 70: 1099-1100 originally published online May 29, 2015
doi: 10.1136/thoraxjnl-2015-207205 Updated information and services can be found at: http://thorax.bmj.com/content/70/11/1099
These include:
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This article cites 3 articles, 0 of which you can access for free at: http://thorax.bmj.com/content/70/11/1099#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Thorax Images in Thorax (117) Screening (oncology) (350) Journalology (100) Pulmonary embolism (127) Transplantation (166) Venous thromboembolism (144)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Chest clinic
IMAGES IN THORAX
Cerebral air embolism during CT-guided lung biopsy Rafael Dahmer Rocha, André Arantes Azevedo, Priscila Mina Falsarella, Antônio Rahal Jr, Rodrigo Gobbo Garcia Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, São Paulo, São Paulo, Brazil Correspondence to Dr Rafael Dahmer Rocha, Department of Interventional Radiology, Hospital Israelita Albert Einstein, Avenida Albert Einsten, 627/701 - Morumbi, São Paulo - São Paulo 05652900, Brazil; [email protected]
A patient with cirrhosis and hepatocellular carcinoma, on the waiting list for liver transplantation, presented with lung nodule during initial evaluation. A CT-guided core needle lung biopsy under general anaesthesia was performed. Pneumothorax (figure 1) and a large amount of gas within the left ventricle (figure 2) were identified during the procedure. Neurological focal signs (drowsiness,
conjugate eye deviation and right hemiparesis) were observed in the anaesthesia-recovery period. A brain CT scan was immediately obtained,
Chest clinic
Received 21 April 2015 Accepted 14 May 2015 Published Online First 29 May 2015
Figure 1 CT-guided lung biopsy of the nodule was performed with a 20-gauge needle and the patient in supine position. A small pneumothorax was already seen in this image.
To cite: Rocha RD, Azevedo AA, Falsarella PM, et al. Thorax 2015;70:1099–1100.
Figure 2 The repeated CT image showed a large amount of gas within the left ventricle.
Figure 3 Axial CT of the brain showed gas locules within the left parietal lobe.
Figure 4 Magnetic resonance image after 5 days revealed the real extension of the embolism. A massive stroke involving both sides of the brain can be seen.
Rocha RD, et al. Thorax 2015;70:1099–1100. doi:10.1136/thoraxjnl-2015-207205
1099
Downloaded from http://thorax.bmj.com/ on December 10, 2015 - Published by group.bmj.com
Chest clinic Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed.
REFERENCES 1
2
3
Ishii H, Hiraki T, Gobara H, et al. Risk factors for systemic air embolism as a complication of percutanenous CT-guided lung biopsy: multicenter case-control study. Cardiovasc Intervent Radiol 2014;37:1312–20. Freund MC, Petersen J, Goder KC, et al. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulm Med 2012;12:2. Hare SS, Gupta A, Gonçalves ATC, et al. Systemic arterial air embolism after percutaneous lung biopsy. Clin Radiol 2011;66:589–96.
Chest clinic
showing cerebral air embolism (figure 3). Initial resuscitation and hyperbaric oxygen therapy were performed. Five days later, MRI revealed a massive stroke (figure 4). At 3-month follow-up, the patient recovered motor functions, however, maintained with important cognitive deficits. Systemic air embolism is a rare but potentially life-threatening complication of percutaneous lung biopsy. The incidence ranges from 0.02% to 0.5%.1–3 Coughing during the procedure, cystic or cavitary lesion, positive pressure ventilation and needle-tip placement through a pulmonary vein are the most common predisposing factors. The management involves high-flow 100% oxygen and early hyperbaric oxygen therapy.
1100
Rocha RD, et al. Thorax 2015;70:1099–1100. doi:10.1136/thoraxjnl-2015-207205
Downloaded from http://thorax.bmj.com/ on December 10, 2015 - Published by group.bmj.com
Cerebral air embolism during CT-guided lung biopsy Rafael Dahmer Rocha, André Arantes Azevedo, Priscila Mina Falsarella, Antônio Rahal, Jr and Rodrigo Gobbo Garcia Thorax 2015 70: 1099-1100 originally published online May 29, 2015
doi: 10.1136/thoraxjnl-2015-207205 Updated information and services can be found at: http://thorax.bmj.com/content/70/11/1099
These include:
References Email alerting service
Topic Collections
This article cites 3 articles, 0 of which you can access for free at: http://thorax.bmj.com/content/70/11/1099#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Thorax Images in Thorax (117) Screening (oncology) (350) Journalology (100) Pulmonary embolism (127) Transplantation (166) Venous thromboembolism (144)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
