1
|
Pigaiani N, Barbiero G, Balestro E, Ausania F, McCleskey B, Begni E, Bortolotti F, Brunelli M, De Leo D. Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice? Forensic Sci Med Pathol 2024; 20:199-204. [PMID: 37160632 PMCID: PMC10944409 DOI: 10.1007/s12024-023-00639-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
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.
Collapse
Affiliation(s)
- Nicola Pigaiani
- 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.
| | - Giulio Barbiero
- Unit of Radiology, Department of Medicine, University of Padova, University Hospital, 35128, Padua, Italy
| | - Elisabetta Balestro
- Unit of Respiratory Diseases, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, University Hospital, 35128, Padua, Italy
| | - Francesco Ausania
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Brandi McCleskey
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA
| | - Erica Begni
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Federica Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Matteo Brunelli
- Unit of Pathology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Domenico De Leo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| |
Collapse
|
2
|
Wingren CJ. Commentary on "Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice?". Forensic Sci Med Pathol 2024; 20:295-296. [PMID: 37357244 DOI: 10.1007/s12024-023-00667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
To differentiate between medical malpractice and expected, but rare, medical complication in a medicolegal autopsy context is often difficult. Such an assessment requires knowledge about the clinical practice associated with the procedure at hand, and that findings of the autopsy, including medical relevant information such as patient chart, radiological imaging, and statements from witnesses about the medical procedure itself, provides evidence that substantiate either conclusion. In a case report published in the journal such an assessment is discussed by presenting findings and circumstances surrounding the death of a patient during a percutaneous needle lung biopsy procedure. The authors conclude that the death was not due to medical malpractice. However, in this commentary it is highlighted that the reasoning behind the conclusion needs to be further substantiated.
Collapse
Affiliation(s)
- Carl Johan Wingren
- Forensic Medicine Unit, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Sölvegatan 25, 223 62, Lund, Sweden.
| |
Collapse
|
3
|
Sun SL, Yang ZJ, Sun HL, Huang ZG, Xu YY, Wang YL, Gao BX, Li CD. Air embolism after CT-guided localization of pulmonary ground-glass nodules. Br J Radiol 2023; 96:20220583. [PMID: 37660366 PMCID: PMC10546455 DOI: 10.1259/bjr.20220583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS). METHODS The data of all patients who received CT-guided localization of GGNs before VATS from May 2020 to October 2021 were retrospectively analyzed. RESULTS A total of 1395 consecutive patients with 1553 GGNs were enrolled. AEs occurred in seven patients (0.5%). In four of the seven patients with AE, the embolism was detected before the patients left the CT table and emergency treatments were carried out. Among them, one patient had chest tightness and unilateral limb dyskinesia, one patient had convulsions and transient loss of consciousness, and two patients had no definite clinical symptoms. After a short-term high-flow oxygen inhalation, the clinical symptoms of two patients with symptomatic AE disappeared and two patients with asymptomatic AE did not show any symptoms. In the remaining three patients with AE, the embolism were detected retrospectively when evaluating the images in the PACS for this study. Fortunately, these three patients never developed clinical symptoms related to AE. All seven patients with AE underwent VATS on the day of localization and all GGNs were successfully removed under the guidance of markers. CONCLUSION The incidence of AE related to CT-guided localization of GGNs was 0.5%, which was significantly higher than expected. Post-localization whole thoracic CT should be performed and observed carefully so as to avoid missed AE and delayed treatment. ADVANCES IN KNOWLEDGE The incidence of AE related to CT-guided localization of GGNs was 0.5%. In order to timely detect AE, whole thoracic CT scan rather than local CT in the lesion area should be performed after localization. A small amount of AE may be missed if the post- localization CT images are not carefully observed.
Collapse
Affiliation(s)
- Shi-long Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zeng-jian Yang
- Department of the Second Ward of Respiratory and Critical Care Medicine, Zhucheng People’s Hospital, Shandong Province, China
| | - Hong-liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yan-yan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yu-li Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bao-xiang Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Chuan-dong Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
4
|
Bennett K, Totton K, Misacas A, Caswell F, Miller D. Transient visual loss following CT-guided percutaneous core needle biopsy of a lung lesion. Thorax 2023; 78:316-317. [PMID: 36207125 DOI: 10.1136/thorax-2022-219314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Karina Bennett
- Department of Respiratory, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Karla Totton
- Department of Stroke, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Arianna Misacas
- Department of Respiratory, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Fiona Caswell
- Department of Radiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David Miller
- Department of Respiratory, Aberdeen Royal Infirmary, Aberdeen, UK
| |
Collapse
|
5
|
Maehara Y, Miura H, Hirota T, Asai S, Okamoto T, Ohara Y, Yamada K. Frequency and Risk Factors for Air Embolism in Computed Tomography Fluoroscopy-Guided Biopsy of Lung Tumor With the Use of Noncoaxial Automatic Needle. J Comput Assist Tomogr 2023; 47:71-77. [PMID: 36194845 DOI: 10.1097/rct.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy-guided lung biopsies using noncoaxial automatic needle. MATERIALS AND METHODS Between February 2014 and December 2019, 204 CT fluoroscopy-guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed. RESULTS The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein ( P = 0.0478) and higher location relative to left atrium ( P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively. CONCLUSIONS In CT fluoroscopy-guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.
Collapse
Affiliation(s)
- Yosuke Maehara
- From the Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
6
|
Nguyen ET, Bayanati H, Hurrell C, Aitken M, Cheung EM, Gupta A, Harris S, Sedlic T, Taylor JL, Gahide G, Dennie C. Canadian Association of Radiologists/Canadian Association of Interventional Radiologists/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions. Can Assoc Radiol J 2022; 74:272-287. [PMID: 36154303 DOI: 10.1177/08465371221122807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association of Interventional Radiologists and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management.
Collapse
Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Hamid Bayanati
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Matthew Aitken
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,St. Michael's Hospital, University of Toronto, ON, Canada
| | - Edward M Cheung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Ashish Gupta
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Scott Harris
- Health Sciences Centre, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tony Sedlic
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gerald Gahide
- Service de radiologie interventionelle, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
7
|
Li YW, Chen C, Xu Y, Weng QP, Qian SX. Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy: A case report. World J Clin Cases 2022; 10:5456-5462. [PMID: 35812676 PMCID: PMC9210916 DOI: 10.12998/wjcc.v10.i16.5456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/01/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology, but entails a risk of complications including systematic air embolism (SAE). While SAE is often well tolerated, it can be difficult to treat and may result in rapid mortality in some cases.
CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe. Shortly following needle extraction, she experienced a mild cough, hemoptysis, rapid-onset unconsciousness, and cardiopulmonary arrest. Cardiopulmonary resuscitation was immediately performed, but the patient died 40 min after the procedure. A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.
CONCLUSION Although SAE is generally well tolerated and asymptomatic, interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols. In this report, the characteristics, mechanisms, and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.
Collapse
Affiliation(s)
- Yi-Wei Li
- Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Can Chen
- Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Ying Xu
- Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Qian-Ping Weng
- Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Shen-Xian Qian
- Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| |
Collapse
|
8
|
Pietersen PI, Kristjansdottir B, Laursen C, M Jørgensen G, Graumann O. Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion – a systematic search of case reports and case series. Acta Radiol Open 2022; 11:20584601221096680. [PMID: 35770135 PMCID: PMC9234839 DOI: 10.1177/20584601221096680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Systemic air embolism is a rare, however potentially fatal, low incidence, complication to CT-guided transthoracic needle biopsy of lung lesions. Purpose The purpose of this review of case reports and series was to pool data about this rare complication and glance for a pattern or similarities in the patients’ initial symptoms and course, as well as the management of the patients in relation to current guidelines. Material and methods PubMed was searched for case reports and case series about systemic air embolisms following CT-guided transthoracic needle biopsy of lung lesions from inception to November 2021. A reviewer screened the results for eligibility and included studies which reported at least two outcomes of interest. Data was extracted by one author and a descriptive analysis was conducted. Results Of 1,136 studies screened, 83 were eligible for inclusion involving 97 patients. The mean age was 64.8±11.7 years and ≈60% of the patients were men. In 15 cases the outcome was fatal, and most of the fatal cases ( n = 12) had cardiac arrest as the primary initial symptom. In addition to conventional oxygen therapy, 34 patients received hyperbaric oxygen therapy, and in 30 cases the physician in charge chose to change the patient from standard supine position to – most often – Trendelenburg position. Conclusion No similarities were found that could lead to more rapid diagnosis or more correct management. The staff should keep systemic air embolisms in mind, when more common complications are ruled out, and consider hyperbaric oxygen therapy in case of suspicion.
Collapse
Affiliation(s)
- Pia I Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
| | - Björg Kristjansdottir
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
| | - Christian Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte M Jørgensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Odense
| |
Collapse
|
9
|
Swenson KE, Shaller BD, Duong K, Bedi H. Systemic arterial gas embolism (SAGE) as a complication of bronchoscopic lung biopsy: a case report and systematic literature review. J Thorac Dis 2022; 13:6439-6452. [PMID: 34992823 PMCID: PMC8662492 DOI: 10.21037/jtd-21-717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022]
Abstract
Background Systemic arterial gas embolism (SAGE) is a rare yet serious and underrecognized complication of bronchoscopic procedures. A recent case of presumed SAGE after transbronchial needle aspiration prompted a systematic literature review of SAGE after biopsy procedures during flexible bronchoscopy. Methods We performed a systematic database search for case reports and case series pertaining to SAGE after bronchoscopic lung biopsy; reports or series involving only bronchoscopic laser therapy or argon plasma coagulation (APC) were excluded. Patient data were extracted directly from published reports. Results A total of 29 unique patient reports were assessed for patient demographics, specifics of the procedure, clinical manifestations, diagnostic findings, and clinical outcomes. Cases of SAGE occurred after multiple types of bronchoscopic biopsy and under both positive and negative pressure ventilation. The most common clinical findings were neurologic, followed by cardiac manifestations; temporal patterns included acute onset of cardiac or neurologic emergencies immediately after biopsy, or delayed awakening post-procedure. There was a high mortality rate among cases (28%), with residual neurologic deficits also common (24%). Discussion SAGE is an underrecognized but severe adverse effect of bronchoscopic lung biopsy, which often presents with acute coronary or cerebral ischemia or delayed awakening from sedation. It is important for all physicians who perform bronchoscopic biopsies to be aware of the clinical manifestations and therapeutic management of SAGE in order to mitigate morbidity and mortality among patients undergoing these procedures.
Collapse
Affiliation(s)
- Kai E Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian D Shaller
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin Duong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Harmeet Bedi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
10
|
Asymptomatic air collection in the left atrium after computed tomography-guided lung biopsy. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:129-131. [PMID: 35444861 PMCID: PMC8990148 DOI: 10.5606/tgkdc.dergisi.2022.21058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/07/2021] [Indexed: 11/21/2022]
Abstract
Systemic air embolism is a fatal lung biopsy complication, despite its low incidence. Incidental air immigration into the pulmonary vein passing through the left heart circulation results in air embolism in percutaneous lung biopsy. Herein, we report a 73-year-old man who presented with massive air collection in the left atrium after computed tomography-guided lung biopsy which resolved without any symptom. Computed tomography fluoroscopy confirmed the gradual absorption process.
Collapse
|
11
|
Fang X, Li J, Sun B, Liu M, Tang Z. Underestimated pulmonary hemorrhage-a fatal complication combined with systemic air embolism after CT-guided lung biopsy: a case description. Quant Imaging Med Surg 2021; 11:4661-4666. [PMID: 34737931 DOI: 10.21037/qims-20-1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/04/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Xingyu Fang
- Department of Radiology, PLA 305 Hospital, Beijing, China
| | - Jialin Li
- Department of Laboratory, PLA 305 Hospital, Beijing, China
| | - Bin Sun
- Department of Radiology, PLA 305 Hospital, Beijing, China
| | - Mingxia Liu
- Department of Radiology, PLA 305 Hospital, Beijing, China
| | - Zhiquan Tang
- Department of Radiology, PLA 305 Hospital, Beijing, China
| |
Collapse
|
12
|
Goiffon RJ, Best TD, Wrobel MM, McDermott S, Sharma A, Chang CY, Yang K, Fintelmann FJ. Reducing Time and Patient Radiation of Computed Tomography-guided Thoracic Needle Biopsies With Single-rotation Axial Acquisitions: An Alternative to "CT Fluoroscopy". J Thorac Imaging 2021; 36:389-396. [PMID: 34534997 DOI: 10.1097/rti.0000000000000609] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the effect on procedure time and patient radiation indices of replacing helical acquisitions for needle guidance during thoracic needle biopsy (TNB) with intermittent single-rotation axial acquisitions. MATERIALS AND METHODS This retrospective intervention study included 215 consecutive TNBs performed by a single operator from 2014 to 2018. Characteristics of patients, lesions, and procedures were compared between TNBs guided only by helical acquisitions initiated in the control room (helical group, n=141) and TNBs guided in part by intermittent single-rotation axial computed tomography controlled by foot pedal (single-rotation group, n=74). Procedure time and patient radiation indices were primary outcomes, complications, and radiologist radiation dose were secondary outcomes. RESULTS Patient, lesion, and procedural characteristics did not differ between helical and single-rotation groups. Use of single-rotation axial acquisitions decreased procedure time by 10.5 minutes (95% confidence interval [CI]: 8.2-12.8 min) or 27% (95% CI: 22%-32%; P<0.001). Patient dose in cumulative volume computed tomography dose index decreased by 23% (95% CI: 12%-33%) or 8 mGy (95% CI: 4.3-31.6 mGy; P=0.01). Dose-length product decreased by 50% (95% CI: 40%-60%) or 270 mGy cm (95% CI: 195-345 mGy cm; P<0.001). No operator radiation exposure was detected. Rate of diagnostic result, pneumothorax, hemoptysis, and hemorrhage did not differ between groups. CONCLUSIONS Replacing helical acquisitions with intermittent single-rotation axial acquisitions significantly decreases TNB procedure time and patient radiation indices without adversely affecting diagnostic rate, procedural complications, or operator radiation dose.
Collapse
Affiliation(s)
- Reece J Goiffon
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Till D Best
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin
| | - Maria M Wrobel
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Kai Yang
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | |
Collapse
|
13
|
Abstract
ABSTRACT Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.
Collapse
|
14
|
Goto T. Effect of the coronavirus disease pandemic on bronchoscopic diagnosis of lung cancer in a provincial city in Japan. J Cardiothorac Surg 2021; 16:115. [PMID: 33910601 PMCID: PMC8080994 DOI: 10.1186/s13019-021-01501-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/19/2021] [Indexed: 01/05/2023] Open
Affiliation(s)
- Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan.
| |
Collapse
|
15
|
Systemic Air Embolism Complicating Computed Tomography-guided Percutaneous Transthoracic Biopsy of Cavitary Lung Lesions: A Systematic Review. J Thorac Imaging 2021; 36:218-223. [PMID: 33631775 DOI: 10.1097/rti.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cavitary lung lesions often pose a diagnostic challenge, and tissue sampling can be required to obtain a confident diagnosis. Many authors contend that a computed tomography-guided percutaneous transthoracic lung biopsy (PTLB) of a cavitary lung lesion places a patient at higher risk for systemic air embolism (SAE) compared with biopsy of a noncavitary lesion. MATERIALS AND METHODS We reviewed the literature for studies of SAE complicating PTLB. We searched English-language articles indexed through PubMed, Embase, and Ovid Medline and included articles published up to March 31, 2020. RESULTS We identified 10 case reports of SAE complicating PTLB, and 3 case-cohort studies comparing cavitary and noncavitary lesion biopsy. Among the case-cohort studies reviewed, 4 SAE occurred among 145 biopsies of cavitary lesions (2.7%), and 65 SAE occurred among 3050 biopsies of noncavitary lesions (2.1%). The pooled odds ratio of PTLB complicating SAE of cavitary lesions compared with noncavitary lesions was 1.29 (95% confidence interval: 0.47-3.60). No deaths following SAE after computed tomography-guided PTLB of cavitary lesions were reported in recent literature. CONCLUSIONS On the basis of available evidence, air embolism rates are similar for PTLB of cavitary and noncavitary lesions. Additional research and registry studies are necessary to better understand this topic.
Collapse
|
16
|
|
17
|
Goto T. Is tomosynthesis an ingenious scheme for bronchoscopic diagnosis of lung nodules? Respirology 2020; 26:125. [PMID: 33202480 PMCID: PMC7756326 DOI: 10.1111/resp.13975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 01/05/2023]
Abstract
See related Reply
Collapse
Affiliation(s)
- Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| |
Collapse
|
18
|
Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis. Eur Radiol 2020; 31:2022-2033. [PMID: 33051730 PMCID: PMC7979673 DOI: 10.1007/s00330-020-07372-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022]
Abstract
Objectives To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. Methods We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. Results The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048–0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029–34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103–91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725–14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149–9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309–20.447; p = 0.019). Conclusion The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. Key Points • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.
Collapse
|
19
|
Najafi A, Baere TD, Madani K, Al-Ahmar M, Roux C, Delpla A, Deschamps F, Tselikas L. Lung Ablation - How I Do It. Tech Vasc Interv Radiol 2020; 23:100673. [PMID: 32591189 DOI: 10.1016/j.tvir.2020.100673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Interventional oncology and the value of thermal ablation of small tumors is increasingly recognized by the oncological community. Primary lung cancers and lung metastases have been one of the most researched applications of percutaneous ablation and as interventional oncologists gain more experience and confidence, it is becoming a more effective treatment with expanding indications. Importantly, the current literature does not demonstrate major differences in survival between ablation, sublobar resection, and stereotactic body radiation. The advantages of percutaneous ablation over other local therapies like surgery or SBRT are significantly lower morbidity, mortality, and repeatability of treatments. The focus of this essay is to highlight technical and procedural aspects of lung ablation as well as management and follow-up in a practical fashion.
Collapse
|
20
|
Capron T, Guinde J, Laroumagne S, Dutau H, Astoul P. Cerebral Air Embolism After Pleural Lavage for Empyema. Ann Thorac Surg 2020; 110:e289-e291. [PMID: 32246936 DOI: 10.1016/j.athoracsur.2020.02.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 01/05/2023]
Abstract
Percutaneous pleural maneuvers are performed routinely in the management of pleural diseases with a favorable safety profile. We report a case of cerebral air embolism during a pleural lavage for the management of an empyema. This severe complication is rarely reported in the literature, although it can happen after any percutaneous thoracic procedures. Asymptomatic arterial air emboli can occur in up to 5% of percutaneous thoracic maneuvers. Diagnosis should be made upon sudden neurologic signs and confirmed with brain imaging. Standard treatment is based on hyperbaric oxygen therapy, and it can be performed safely with an intrapleural catheter.
Collapse
Affiliation(s)
- Thibaut Capron
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Aix-Marseille University, Marseille, France
| |
Collapse
|