Hiraki Takao, Fujiwara Hiroyasu, Sakurai Jun, Iguchi Toshihiro, Gobara Hideo, Tajiri Nobuhisa, Mimura Hidefumi, Kanazawa Susumu
Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Okayama 700-8558, Japan.
Chest. 2007 Aug;132(2):684-90. doi: 10.1378/chest.06-3030.
Systemic air embolism is recognized as a potentially fatal but extremely rare complication following percutaneous transthoracic needle biopsy. However, its incidence might be underestimated by missing systemic air in patients without cardiac or cerebral symptoms.
This study was based on four cases (one man and three women; age range, 54 to 75 years) of systemic air embolism complicating CT scan-guided transthoracic needle biopsy, which were encountered among 1,010 procedures performed at our institution from April 1999 to December 2006. The target lesion was a lung tumor in three patients, and a mediastinal tumor in one patient. The procedure was performed percutaneously under CT scan-fluoroscopic guidance by using a coaxial biopsy needle system.
In all four patients, a specimen was successfully obtained from the lesions. During or immediately after the procedure, all patients experienced paroxysms of coughing. In three patients without cardiac or cerebral symptoms, the presence of systemic air was confirmed on postprocedural CT scan images; it was resolved without causing morbidity after the immediate therapy. The presence of systemic air was missed in one initially asymptomatic patient, resulting in a subsequent neurologic deficit.
Systemic air embolism following CT scan-guided transthoracic needle biopsy was encountered more frequently than would be expected. The considerable attention we gave to this complication enabled us to recognize it in patients without cardiac or cerebral symptoms. No sequelae were observed in the three patients in whom systemic air embolism was detected, and the therapy was initiated immediately, whereas missing systemic air led to cerebral embolism in one patient in our four cases.
系统性空气栓塞被认为是经皮经胸针吸活检术后一种潜在致命但极为罕见的并发症。然而，在没有心脏或脑部症状的患者中，系统性空气的漏诊可能会低估其发生率。
本研究基于1999年4月至2006年12月在我院进行的1010例CT扫描引导下经胸针吸活检术中发生的4例系统性空气栓塞病例（1例男性和3例女性；年龄范围为54至75岁）。3例患者的目标病变为肺部肿瘤，1例患者为纵隔肿瘤。该操作在CT扫描-透视引导下经皮使用同轴活检针系统进行。
所有4例患者均成功从病变处获取标本。在操作过程中或操作后即刻，所有患者均出现阵发性咳嗽。3例无心脏或脑部症状的患者在术后CT扫描图像上证实存在系统性空气；经即刻治疗后空气消散，未引起并发症。1例最初无症状的患者漏诊了系统性空气，导致随后出现神经功能缺损。
CT扫描引导下经胸针吸活检术后系统性空气栓塞的发生率比预期的更高。我们对该并发症的高度关注使我们能够在没有心脏或脑部症状的患者中识别出该并发症。在检测到系统性空气栓塞的3例患者中，立即开始治疗，未观察到后遗症，而在我们的4例病例中，1例患者因漏诊系统性空气导致脑栓塞。
