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Chen Z, Zeng J, Lin Y, Zhang X, Wu X, Yong Y, Tang L, Ke M. Synchronous Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy and Microwave Ablation for Highly Suspicious Malignant Pulmonary Ground-Glass Nodules. Respiration 2024; 103:388-396. [PMID: 38599179 DOI: 10.1159/000538743] [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] [Received: 10/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION There is no consensus regarding the most appropriate management of suspected malignant pulmonary ground-glass nodules (GGNs). OBJECTIVE We aimed to explore the feasibility and safety of synchronous computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) and microwave ablation (MWA) for patients highly suspicious of having malignant GGNs. METHODS We retrospectively reviewed medical records between July 2020 and April 2023 from our medical center. Eligible patients synchronously underwent PTNB and MWA (either MWA immediately after PTNB [PTNB-first group] or PTNB immediately after MWA [MWA-first group]) at the the physician's discretion. We analyzed the rate of definitive diagnosis and technical success, the length of hospital stay, the postoperative efficacy, and periprocedural complications. RESULTS Of 65 patients who were enrolled, the rate of definitive diagnosis was 86.2%, which did not differ when stratified by the tumor size, the consolidation-to-tumor ratio, or the sequence of the two procedures (all p > 0.05). The diagnostic rate of malignancy was 83.1%. After the median follow-up duration of 18.5 months, the local control rate was 98.2% and the rate of completed ablation was 48.2%. The rate of perioperative minor and major complications was 44.6% and 6.2%, respectively. The most common adverse events included pain, cough, and mild hemorrhage. Mild hemorrhage took place significantly less frequently in the MWA-first group than in the PTNB-first group (16.7% vs. 45.5%, p < 0.05). CONCLUSION Synchronous PTNB and MWA are feasible and well tolerated for patients highly suspicious of having malignant GGNs, providing an alternative option for patients who are ineligible for surgical resection.
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Affiliation(s)
- Zhide Chen
- Department of Respiratory and Critical Care Medicine, West China Xiamen Hospital of Sichuan University, Xiamen, China
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Junli Zeng
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yan Lin
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xiaoling Zhang
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xuemei Wu
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yazhi Yong
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Lihua Tang
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Mingyao Ke
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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Ricciardella F, Mannetta G, Caruso V, Cocco G, Mantini C, Piccirilli E, Caulo M, Delli Pizzi A. Air embolism as a rare complication of lung biopsy: A case report. Radiol Case Rep 2024; 19:1547-1551. [PMID: 38317699 PMCID: PMC10839755 DOI: 10.1016/j.radcr.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Lung biopsy is an important interventional radiology procedure allowing the characterization of lesions with suspected malignancy. The most frequent complications are pneumothorax and hemorrhage. Air embolism is a rare but potentially fatal occurrence. In this case report, we present an air embolism after core needle CT-guided biopsy showing CT and MRI features that radiologists should expect in the everyday clinical practice.
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Affiliation(s)
- Federica Ricciardella
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Gianluca Mannetta
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Valentina Caruso
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Cesare Mantini
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Massimo Caulo
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Radiology, SS. Annunziata Hospital, “G. d'Annunzio” University, Chieti, Via dei Vestini, Chieti, Italy
- Department of Innovative Technologies in Medicine & Odontoiatry, “G. d'Annunzio” University, Chieti, Italy
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Lu H, Yu J, Sun H, Yan S. Acute Coronary Artery Air Embolism Complicating a CT-guided percutaneous lung biopsy: A case report. Heliyon 2024; 10:e27914. [PMID: 38509877 PMCID: PMC10950704 DOI: 10.1016/j.heliyon.2024.e27914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Systemic air embolism is a fatal complication of computed tomography-guided percutaneous lung biopsy. Here, we report a case of acute coronary artery air embolism following computed tomography (CT) guided percutaneous lung biopsy. The patient exhibited cardiac symptoms, and CT showed air density in left ventricle and aorta, indicating air embolism. Trendelenburg positioning and coronary angiography were performed during the treatment, and the patient was discharged without obvious complications.
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Affiliation(s)
- Haotian Lu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Jieqiong Yu
- Department of Emergency, China-Japan Friendship Hospital, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, China
| | - Shengtao Yan
- Department of Emergency, China-Japan Friendship Hospital, China
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Zhang H, Wang S, Zhong F, Liao M. Risk factors for air embolism following computed tomography-guided percutaneous transthoracic needle biopsy: a systematic review and meta-analysis. Diagn Interv Radiol 2023; 29:478-491. [PMID: 36994842 PMCID: PMC10679610 DOI: 10.4274/dir.2022.221187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/07/2022] [Indexed: 01/15/2023]
Abstract
To quantitatively analyze the risk factors for air embolism following computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and qualitatively review their characteristics. The databases of PubMed, Embase, Web of Science, Wanfang Data, VIP information, and China National Knowledge Infrastructure were searched on January 4, 2021, for studies reporting the occurrence of air embolisms following CT-guided PTNB. After study selection, data extraction, and quality assessment, the characteristics of the included cases were qualitatively and quantitatively analyzed. A total of 154 cases of air embolism following CT-guided PTNB were reported. The reported incidence was 0.06% to 4.80%, and 35 (22.73%) patients were asymptomatic. An unconscious or unresponsive state was the most common symptom (29.87%). Air was most commonly found in the left ventricle (44.81%), and 104 (67.53%) patients recovered without sequelae. Air location (P < 0.001), emphysema (P = 0.061), and cough (P = 0.076) were associated with clinical symptoms. Air location (P = 0.015) and symptoms (P < 0.001) were significantly associated with prognosis. Lesion location [odds ratio (OR): 1.85, P = 0.017], lesion subtype (OR: 3.78, P = 0.01), pneumothorax (OR: 2.16, P = 0.003), hemorrhage (OR: 3.20, P < 0.001), and lesions located above the left atrium (OR: 4.35, P = 0.042) were significant risk factors for air embolism. Based on the current evidence, a subsolid lesion, being located in the lower lobe, the presence of pneumothorax or hemorrhage, and lesions located above the left atrium were significant risk factors for air embolism.
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Affiliation(s)
- Hanfei Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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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.
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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
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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.
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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
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7
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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.
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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
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Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation. Cardiovasc Intervent Radiol 2021; 44:903-910. [PMID: 33492452 DOI: 10.1007/s00270-020-02745-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). MATERIALS AND METHODS In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). CONCLUSION Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.
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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.
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Cousin F. Reply to “Percutaneous Lung Biopsy: Smart Positioning – Prone Should be Forbidden”. Cardiovasc Intervent Radiol 2020; 43:940-941. [DOI: 10.1007/s00270-020-02435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/28/2022]
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Rott G. Percutaneous Lung Biopsy: Smart Positioning—Prone Should Be Forbidden. Cardiovasc Intervent Radiol 2020; 43:938-939. [DOI: 10.1007/s00270-020-02410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
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Huo YR, Chan MV, Habib AR, Lui I, Ridley L. Pneumothorax rates in CT-Guided lung biopsies: a comprehensive systematic review and meta-analysis of risk factors. Br J Radiol 2020; 93:20190866. [PMID: 31860329 DOI: 10.1259/bjr.20190866] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. METHODS A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. RESULTS 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). CONCLUSION This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. ADVANCES IN KNOWLEDGE Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.
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Affiliation(s)
- Ya Ruth Huo
- Bankstown-Campbelltown Hospital, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Michael Vinchill Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia.,University of Sydney, Faculty of Medicine, Sydney, Australia
| | - Al-Rahim Habib
- University of Sydney, Faculty of Medicine, Sydney, Australia
| | - Isaac Lui
- Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia
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Rott G. Comment on "Air Embolism". Cardiovasc Intervent Radiol 2018; 42:163. [PMID: 30167773 DOI: 10.1007/s00270-018-2070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Gernot Rott
- Radiological Department, Bethesda-Hospital Duisburg, Duisburg, Germany.
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14
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Flagg ER, Henry TS, Elicker BM, Kallianos KG, Ordovas KG, Naeger DM. Periprocedural Management in Transthoracic Needle Biopsy: Review of the Current Evidence. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Khalid F, Rehman S, AbdulRahman R, Gupta S. Fatal air embolism following local anaesthetisation: does needle size matter? BMJ Case Rep 2018; 2018:bcr-2017-222254. [PMID: 29437732 DOI: 10.1136/bcr-2017-222254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Faiza Khalid
- Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sofiya Rehman
- Univeristy of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rania AbdulRahman
- Division of Pulmonary and Critical care medicine, University Hospitals/ Case Western University Hospital, Cleveland, OH, USA
| | - Shikha Gupta
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Complications of CT-guided transthoracic lung biopsy : A short report on current literature and a case of systemic air embolism. Wien Klin Wochenschr 2018; 130:288-292. [PMID: 29362884 PMCID: PMC5916998 DOI: 10.1007/s00508-018-1317-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (PCNB) is a common diagnostic procedure and is especially indispensable in thoracic oncology. Complications, such as pulmonary hemorrhage and pneumothorax are frequent, but usually easy to manage. Systemic air embolism is a rare but relevant adverse event and its true incidence is probably underestimated, as not all cases may become clinically apparent. We present a case of systemic air embolism following a core-needle biopsy of a left upper lobe lesion, where immediately after the procedure CT scans documented air in the thoracic aorta and in the left ventricle. In this context, we review the current literature on technical aspects as well as on frequent and infrequent major complications of PCNB, together with risk factors, emergency treatment and prevention strategies.
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Lung Biopsy: Don't Forget Air Embolism! : Letter Reply to "Comment on CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)". Cardiovasc Intervent Radiol 2017; 40:1960-1961. [PMID: 28717839 DOI: 10.1007/s00270-017-1747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 01/05/2023]
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18
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Hasegawa T, Kondo C, Sato Y, Inaba Y, Yamaura H, Kato M, Murata S, Onoda Y, Kuroda H, Sakao Y, Yatabe Y. Pathologic Diagnosis and Genetic Analysis of a Lung Tumor Needle Biopsy Specimen Obtained Immediately After Radiofrequency Ablation. Cardiovasc Intervent Radiol 2017; 41:594-602. [PMID: 29164309 DOI: 10.1007/s00270-017-1845-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the possibility of pathologic diagnosis and genetic analysis of percutaneous core-needle biopsy (CNB) lung tumor specimens obtained immediately after radiofrequency ablation (RFA). MATERIALS AND METHODS Patients who underwent CNB of lung tumors immediately after RFA from May 2013 to May 2016 were analyzed. There were 19 patients (8 men and 11 women; median age, 69 years; range, 52-88 years) and 19 lung tumors measuring 0.5-2.6 cm (median, 1.6 cm). Thirteen tumors were solid, and 6 were predominantly ground-glass opacity (GGO) on computed tomography. All specimens were pathologically examined using hematoxylin and eosin (H&E) staining and additional immunostaining, as necessary. The specimens were analyzed for EGFR and KRAS genetic mutations. The safety and technical success rate of the procedure and the possibility of pathologic diagnosis and genetic mutation analysis were evaluated. RESULTS Major and minor complication rates were 11% (2/19) and 53% (10/19), respectively. Tumor cells were successfully obtained in 16 cases (84%, 16/19), and technical success rate was significantly lower for GGO-dominant tumors (50%, 3/6) compared with solid lesions (100%, 13/13, p = 0.02). Pathologic diagnosis was possible in 79% (15/19) of cases based on H&E staining alone (n = 12) and with additional immunostaining (n = 3). Although atypical cells were obtained, pathologic diagnosis could not be achieved in 1 case (5%, 1/19). Both EGFR and KRAS mutations could be analyzed in 74% (14/19) of the specimens. CONCLUSION Pathologic diagnosis and genetic analysis could be performed even for lung tumor specimens obtained immediately after RFA.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan.
| | - Chiaki Kondo
- Department of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Mina Kato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yui Onoda
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, 1-1 Chikusa-ku Kanokoden, Nagoya, Aichi, 464-8681, Japan
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19
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Rott G. Comment on "CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)". Cardiovasc Intervent Radiol 2017; 40:1958-1959. [PMID: 28707093 DOI: 10.1007/s00270-017-1746-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 07/09/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Gernot Rott
- Department of Radiology, Bethesda-Hospital, Heerstr. 219, 47053, Duisburg, Germany.
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20
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Fiore L, Frenk NE, Martins GLP, Viana PCC, de Menezes MR. Systemic Air Embolism after Percutaneous Lung Biopsy: A Manageable Complication. J Radiol Case Rep 2017; 11:6-14. [PMID: 29299093 DOI: 10.3941/jrcr.v11i6.2990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.
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Affiliation(s)
- Lucas Fiore
- Radiology and Image Guided Intervention Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - Nathan Elie Frenk
- Radiology Department, Hospital das Clínicas, University of São Paulo, Sao Paulo, Brazil
| | - Guilherme Lopes Pinheiro Martins
- Radiology and Image Guided Intervention Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Radiology and Imaged Guided Intervention Service, Hospital Sírio Libanes, São Paulo, Brazil
| | - Publio Cesar Cavalcante Viana
- Radiology and Image Guided Intervention Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Radiology and Imaged Guided Intervention Service, Hospital Sírio Libanes, São Paulo, Brazil
| | - Marcos Roberto de Menezes
- Radiology and Image Guided Intervention Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
- Radiology Department, Hospital das Clínicas, University of São Paulo, Sao Paulo, Brazil
- Radiology and Imaged Guided Intervention Service, Hospital Sírio Libanes, São Paulo, Brazil
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21
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Ohuchi M, Inoue S, Ozaki Y, Ueda K. Systemic air embolism during pleural lavage for empyema. Gen Thorac Cardiovasc Surg 2016; 65:602-604. [PMID: 27987101 DOI: 10.1007/s11748-016-0737-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/02/2016] [Indexed: 01/05/2023]
Abstract
Pleural lavage has been considered a convenient and safe method that is often performed for empyema. We report a case of systemic air embolism that developed during pleural lavage. A 53-year-old man with empyema in the organizing phase suddenly developed paralysis of the left side of the body and altered level of consciousness during pleural lavage, which was performed in a sitting position without negative pressure suction. Systemic air embolism was diagnosed based on computed tomography. In this case, use of fibrinolytic agents, positioning during pleural lavage, and pressure in an empyema cavity may have predisposed to development of systemic air embolism. Conversion from thoracoscopic therapy to open decortication or fenestration should be considered to prevent this type of complication.
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Affiliation(s)
- Masatsugu Ohuchi
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan.
| | - Shuhei Inoue
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
| | - Yoshitomo Ozaki
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
| | - Keiko Ueda
- Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan
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22
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Kazimirko DN, Beam WB, Saleh K, Patel AM. Beware of positive pressure: coronary artery air embolism following percutaneous lung biopsy. Radiol Case Rep 2016; 11:344-347. [PMID: 27920858 PMCID: PMC5128362 DOI: 10.1016/j.radcr.2016.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/18/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022] Open
Abstract
Patients undergoing percutaneous lung biopsy are at risk of developing a systemic air embolism. Air embolism may manifest as a catastrophic iatrogenic event with ischemic insult to the end organs, with sites of least resistance such as coronary and cerebral circulation the most susceptible. We review the available literature and present a case of iatrogenic air embolism during computed tomography guided percutaenous lung biopsy under general anesthesia. Management, outcome, and periprocedural factors that may have contributed to the complication are discussed.
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Affiliation(s)
- Dmitriy N. Kazimirko
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
- Corresponding author.
| | - William B. Beam
- Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Khalid Saleh
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Akash M. Patel
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
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Rehwald R, Loizides A, Wiedermann FJ, Grams AE, Djurdjevic T, Glodny B. Systemic air embolism causing acute stroke and myocardial infarction after percutaneous transthoracic lung biopsy - a case report. J Cardiothorac Surg 2016; 11:80. [PMID: 27154545 PMCID: PMC4859960 DOI: 10.1186/s13019-016-0478-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/29/2016] [Indexed: 12/18/2022] Open
Abstract
The air embolism in this case was likely to have been caused by positioning the patient in a prone position, which was associated with the lesion to be biopsied being at a maximum height over the left atrium. Due to the resulting negative pressure, air entered through a fistula that formed between the airspace and the pulmonary vein. The air could have been trapped in the left atrium by positioning the patient in left lateral position. The event itself could have been prevented by positioning the patient in an ipsilateral dependent position during the biopsy. In addition to hyperbaric oxygen therapy, the preferred treatment options are positioning maneuvers, administration of pure oxygen, and heparinization.
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Affiliation(s)
- Rafael Rehwald
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Alexander Loizides
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Franz J Wiedermann
- Department of Surgery, University Hospital for Anesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Astrid E Grams
- Department of Radiology, University Hospital for Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Tanja Djurdjevic
- Department of Radiology, University Hospital for Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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