Air embolism during CT-guided transthoracic needle biopsy

Area of Science:

• Radiology
• Interventional Radiology
• Cardiovascular Imaging

Background:

• Transthoracic needle biopsy (TNB) is an invasive procedure.
• Air embolism (AE) is a known, albeit rare, complication.
• General anesthesia is often used for TNB procedures.

Observation:

• During CT-guided TNB, venous and systemic air embolism were observed.
• Air bubbles accumulated in the left heart chambers, right subclavian vein, superior vena cava, and right atrium.
• The likely cause was contrast medium (CM) infusion via a faulty stop-cock or injection valve, creating Venturi forces.

Findings:

• Pressure infusion of contrast medium can entrain air into the venous system during TNB.
• Improperly secured stop-cocks or injection valves are potential sources of air entrainment.
• The observed AE involved both venous and systemic circulation, reaching the heart chambers.

Implications:

• AE prevention during CM infusion requires institutional risk management protocols.
• Recommendations include avoiding stop-cocks and injection valves in pressure-infused IV lines.
• Patient positioning (head-down), high oxygen concentration, antithrombotic therapy, and immobilization may mitigate adverse outcomes.