Massive Systemic Air Embolism During Percutaneous Radiofrequency Ablation of a Primary Lung Tumor

Abstract

We report the case of a systemic air embolism occurring during pulmonary radiofrequency ablation. At the end of the procedure, the patient experienced a sudden myocardial infarction, complicated by ventricular fibrillation, cardiac arrest, and cerebral infarction. Thoracic computed tomography showed an air-blood level inside the left atrium and ventricle, the aortic arch, and the coronary arteries. Cerebral computed tomography showed an infarct in the frontoparietal area. Myocardial infarction and stroke responded to resuscitation measures, including hyperbaric oxygenation. The occurrence of this life-threatening event confirms the need to train experienced anesthesiologists in these new invasive approaches to cancer treatment.

Computerized tomography-guided percutaneous high-dose-rate interstitial brachytherapy for malignant lung lesions

“…Systemic air embolism has been reported as a rare complication, but may prove fatal. [12,13] None of the HDRIBT studies, including ours, has encountered this complication.…”

How I Do It

“…35,39,[47][48][49][50][51] Death from RFA has been reported in patients with a single lung and contralateral pneumonectomy, after FIGURE 2. A, Prone axial CT scans in a 78-year-old man with left lower lobe bronchioloalveolar cell carcinoma during RFA using a single 17-gauge internally cooled electrode.…”

Emerging technologies for the thorax: Indications, management and complications

“…The most common complication of RFA in this review was pneumothorax (4.5–61.1%), of which 3.3–38.9% required a tube thoracostomy. Aside from pneumothorax, there are several other reported complications of RFA, including air embolism, psuedoaneurysm, haemoptysis and death 49,50 . Although the exact stages of tumour invasion were not reported, the median progression‐free interval ranged from 15 to 26.7 months (median = 21 months), and 1‐, 2‐ and 3‐year survival rates were 63–85%, 55–65% and 15–46%, respectively 51 .…”

“…Aside from pneumothorax, there are several other reported complications of RFA, including air embolism, psuedoaneurysm, haemoptysis and death. 49,50 Although the exact stages of tumour invasion were not reported, the median progression-free interval ranged from 15 to 26.7 months (median = 21 months), and 1-, 2-and 3-year survival rates were 63-85%, 55-65% and 15-46%, respectively. 51 Overall, the safety profile in this high-risk group of patients appears acceptable.…”