College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
Department of Internal Medicine, Community Memorial Hospital, Ventura, CA, USA.
Am J Case Rep. 2022 May 29;23:e935587. doi: 10.12659/AJCR.935587.
BACKGROUND CT-guided lung biopsy is a routine procedure used to evaluate suspicious pulmonary lesions that may arise from malignancy or infectious etiology. Common complications such as pneumothorax, bleeding, and rare cases of air embolisms leading to stroke have been documented as well. It is reported that there is a 0.06-0.08% risk of air embolism resulting in stroke in patients undergoing CT-guided lung biopsy. However, other causes of ischemic stroke following lung biopsy should be considered. CASE REPORT A 36-year-old obese man presented with chronic shortness of breath, intermittent fever, and night sweats. Chest CT showed multiple bilateral pulmonary nodules with basilar predominance, and laboratory test results that showed no acute infections, a negative TB QuantiFERON, and a normal transthoracic echocardiogram. Therefore, elective lung biopsy was performed to direct future medical therapy. Shortly after the procedure, the patient reported having right-sided vision loss and decreased sensation on the right half of his face, arms, and legs. Non-contrast CT of the brain showed no hemorrhage and no air intracranially. Therefore, following a Neurology consult, the stroke protocol was initiated, which resulted in tPA being administered. TPA use resolved the patient's symptoms, with no signs of hemorrhage. CONCLUSIONS Air embolisms have commonly been the cause of strokes following CT-guided lung biopsies, which can be detected on CT brain with signs of air intracranially. However, our case presents an ischemic cause of stroke with no evidence of air embolisms intracranially. Multidisciplinary stroke team consultations and consideration of alternative causes of stroke following CT-guided lung biopsy can be lifesaving, as urgent medical therapy can be delayed without proper considerations.
背景 CT 引导下肺活检是一种常规程序，用于评估可能由恶性肿瘤或感染病因引起的可疑肺部病变。已经记录了常见并发症，如气胸、出血，以及罕见的空气栓塞导致中风的病例。据报道，在接受 CT 引导下肺活检的患者中，空气栓塞导致中风的风险为 0.06-0.08%。然而，应该考虑其他导致肺活检后缺血性中风的原因。
病例报告 一名 36 岁肥胖男性因慢性呼吸急促、间歇性发热和夜间盗汗就诊。胸部 CT 显示多个双侧肺部结节，以基底为主，实验室检查结果无急性感染、TB QuantiFERON 阴性和经胸超声心动图正常。因此，进行了选择性肺活检以指导未来的医学治疗。在手术后不久，患者报告出现右侧视力丧失和右侧面部、手臂和腿部感觉减退。脑非对比 CT 未见出血，颅内无空气。因此，在神经科会诊后，启动了中风方案，给予 tPA 治疗。tPA 治疗缓解了患者的症状，没有出血迹象。
结论 CT 引导下肺活检后中风的常见原因是空气栓塞，可以通过 CT 脑扫描发现颅内有空气。然而，我们的病例表现为缺血性中风，颅内无空气栓塞证据。多学科中风团队会诊和考虑 CT 引导下肺活检后中风的其他原因可以挽救生命，因为如果没有适当的考虑，可能会延误紧急医疗治疗。
