Khalid Faiza, Rehman Sofiya, AbdulRahman Rania, Gupta Shikha
Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA.
Univeristy of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2018 Feb 5;2018:bcr-2017-222254. doi: 10.1136/bcr-2017-222254.
A 76--year--old male cigarette smoker presented with a 2-week history of cough and haemoptysis. Chest CT on admission revealed multiple new lung nodules concerning for malignancy. CT--guided biopsy of the nodule in left lower lobe was attempted in prone oblique position for tissue diagnosis. Local anaesthetic (lidocaine) was administered using a 25--gauge (1.5-inch) needle to anaesthetise the skin and subcutaneous tissue. This was followed by insertion of a 25-gauge (3.5-inch) Whitacre needle to anaesthetise deeper tissues and parietal pleura. Due to patient's coughing and proximity of the nodule to the diaphragm, the circumstances were judged to be too risky for a needle biopsy. Therefore, it was decided to biopsy another nodule in the left lung that was visible on the same CT section. During this portion of the procedure, the patient became hypoxic and developed pulseless electrical activity arrest. Cardiopulmonary resuscitation was unsuccessful and the efforts ceased after 45 min. Subsequent review of CT scan revealed air in the left ventricle.
一名76岁男性吸烟者，有2周咳嗽和咯血病史。入院时胸部CT显示多个新的肺部结节，怀疑为恶性。尝试在俯卧斜位对左下叶结节进行CT引导下活检以进行组织诊断。使用25号（1.5英寸）针头注射局部麻醉剂（利多卡因）以麻醉皮肤和皮下组织。随后插入25号（3.5英寸）惠特克针以麻醉更深层组织和壁层胸膜。由于患者咳嗽以及结节靠近膈肌，判断进行针吸活检风险太大。因此，决定对同一CT层面可见的左肺另一个结节进行活检。在该操作过程中，患者出现缺氧并发生无脉电活动骤停。心肺复苏未成功，45分钟后停止抢救。随后复查CT扫描显示左心室内有气体。
