Cerebral air embolism during CT-guided lung biopsy

Rocha, Rafael Dahmer; Azevedo, A.; Falsarella, Priscila Mina; Rahal, Antônio; Garcia, Rodrigo Gobbo

doi:10.1136/thoraxjnl-2015-207205

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…Risk factor for SAAE after CT guided hook wire localization and CT guided lung biopsy include lesion located above left atrium, deep lung lesion far from visceral pleura, patient movement during procedure or increase airway pressure which can occur during coughing, Valsalva maneuver or positive pressure ventilation, repositioning after procedure, deep inspiration [32]. Measures suggested to decrease risk of SAAE during these procedures include avoiding biopsy of cystic, cavitary or bullous lung lesion, not changing patient position suddenly after completing the procedure in addition to keeping needle hub occluded at all times, avoiding coughing and deep inspiration during procedure and penetrate the least amount of lung parenchyma by the needle [33].…”

Section: Discussionmentioning

confidence: 99%

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

Sameh¹,

Umran²,

P³

et al. 2021

J Neurosci Neurol Disord

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Systemic arterial air embolism (SAAE) is a rare but serious complication of CT-guided hook wire localization of pulmonary nodule usually with catastrophic and poor outcome. Hook wire needle localization is done pre-operatively by placing wire around or into the pulmonary nodule to provide the thoracic surgeon accurate location guidance of the target nodule for Video-Assisted Thoracoscopic Surgery (VATS) wedge resection with safety margins. Physicians should be aware of this possible complication during the procedure in order to rescue the patient promptly as it requires rapid diagnosis and management. We describe a 55-year-old male who underwent a CT-guided hook wire needle localization of left upper lobe lung cancer and left lower lobe pulmonary nodule prior to planned VATS wedge resection who developed altered mental status and bilateral lower extremities paralysis after wire placement was completed. His CT head demonstrated small air embolism in the left occipital area, confirming the diagnosis of cerebral air embolism and follow up CT and MRI of the head revealed multiple areas of brain infarction. In addition, he was diagnosed with anterior spinal cord syndrome (ACS), most likely due to anterior spinal artery ischemia from micro air embolism on the basis of clinical findings but with negative ischemic changes on MRI of the spinal cord. His mental status recovered but he remained paraplegic and transferred to inpatient rehabilitation service.

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Section: Discussionmentioning

confidence: 99%

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

Sameh¹,

Umran²,

P³

et al. 2021

J Neurosci Neurol Disord

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“…The only major complication was cerebral air embolism (in 1 patient), a relatively rare complication. 23 …”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

et al. 2018

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Objective:To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods:This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results:A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions:Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.

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“…In addition, this leads to reduced "risky period" to patients, which is characterized by the interval between two procedures with consequent lower morbidity. (19,20) There are lower rates of displacement and pneumothorax, but no differences in hemorrhagic complications, nor in length of hospital stay, or success rates. (2,19,20) In addition, in a hybrid room, if localization failure is suspected, a new tomography can be carried out to provide information and also enable a new implant procedure.…”

Section: Literature Reviewmentioning

confidence: 96%

“…(19,20) There are lower rates of displacement and pneumothorax, but no differences in hemorrhagic complications, nor in length of hospital stay, or success rates. (2,19,20) In addition, in a hybrid room, if localization failure is suspected, a new tomography can be carried out to provide information and also enable a new implant procedure. (2) Preoperative percutaneous localization of lung lesions in hybrid room is an effective and a safe method, which can have decisive impact on surgical resection, with low rates of complications.…”

Section: Literature Reviewmentioning

confidence: 96%

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review

Gilberto¹,

Falsarella²,

Andrade³

et al. 2022

Einstein (São Paulo)

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Objective: To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods: A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results: A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol ® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion: Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

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Cerebral air embolism during CT-guided lung biopsy

Cited by 9 publications

References 3 publications

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review

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