Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy.
Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA.
Forensic Sci Med Pathol. 2024 Mar;20(1):199-204. doi: 10.1007/s12024-023-00639-w. Epub 2023 May 9.
Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.
计算机断层扫描（CT）引导下经皮肺穿刺活检术是一种广泛认可且相对安全的诊断可疑肺部肿块的方法。全身空气栓塞（SAE）是经胸肺穿刺活检术的罕见并发症。本文报道了 1 例 81 岁男性患者，行 CT 引导下右下肺可疑结节经皮穿刺活检术。术后不久，患者咳出鲜血，遂行重复 CT 成像。结果发现患者存在大量心脏空气栓塞。患者意识丧失，尽管进行了复苏抢救，仍被宣布死亡。本文讨论了 SAE 的病理生理学、危险因素、临床特征、影像学证据和尸检结果，根据目前的文献，可能有助于解决评估程序并发症和医疗责任之间的困境。鉴于在长时间手术过程中即使技术操作仔细仍会发生 SAE 的情况，建议提供准确和详尽的信息，包括与手术相关的风险，即使是最罕见但潜在致命的风险，以获得知情同意，从而减少医疗法律诉讼问题。
