Massive coronary air embolism after CT-guided lung needle biopsy
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IMAGING IN INTENSIVE CARE MEDICINE
Massive coronary air embolism after CT‑guided lung needle biopsy E. Ornelas1, S. Fernandez‑Vilches1, X. Gallardo2 and J. Mesquida1* © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
A 70-year-old female with a history of a pulmonary nodule underwent a programmed computerized tomography (CT)-guided lung needle biopsy. During the procedure, immediately after taking off the needle (Fig. 1a), the patient experienced sudden loss of consciousness, cyanosis and severe hypotension, rapidly progressing to cardiac arrest (asystole). After 50 min of advanced life support without recuperation of effective rhythm, resuscitation efforts were terminated, and the patient died.
*Correspondence: [email protected] 1 Critical Care Department, Parc Taulí Hospital Universitari, Parc Tauli, 1, 08208 Sabadell, Spain Full author information is available at the end of the article
The CT images obtained immediately prior to the cardiac arrest showed massive presence of air in the lumen of the ascending thoracic aorta (Fig. 1b) and coronary arteries (Fig. 1c, d). Air embolism is a rare but potentially life-threatening condition that occurs mostly as a complication of an invasive procedure. It usually affects the cerebral arteries, causing neurologic symptoms. When coronary arteries are involved, as little as 0.5–1 ml of the air injected into the pulmonary veins can lead to cardiac arrest.
Fig. 1 Tip of the needle in the pulmonary nodule (a); hydroaeric level in the lumen of the ascending thoracic aorta (b); presence of air in the right (c, d) and circumflex (d) coronary arteries
Author details 1 Critical Care Department, Parc Taulí Hospital Universitari, Parc Tauli, 1, 08208 Sabadell, Spain. 2 Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Sabadell, Spain. Compliance with ethical standards Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.
Received: 26 March 2018 Accepted: 2 April 2018
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