SHM Converge Scientific Abstract ePoster Gallery-Mystery of an Air-a Case of Air Embolism Post Biopsy

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This case report describes a rare and serious complication after CT-guided transthoracic lung biopsy: cerebral/systemic air embolism. A 77-year-old man with metastatic renal cell carcinoma to the lungs underwent an elective biopsy of a lung nodule. Shortly afterward, he developed acute right-sided weakness, difficulty speaking, and altered mental status.<br /><br />Initial vital signs were stable. Chest CT showed air in the left ventricle on the final images, while the biopsy needle was still in the chest wall, supporting the diagnosis of air embolism. Workup for stroke and other causes included a noncontrast head CT and CTA of the head and neck, both of which showed no acute intracranial process, large vessel occlusion, aneurysm, or high-grade stenosis. MRI could not be performed because the patient had a pacemaker.<br /><br />Laboratory values were notable for mild thrombocytopenia, elevated potassium, and creatinine. Chest x-ray showed no pneumothorax. In the ICU, the patient remained awake and oriented but had persistent right upper extremity weakness.<br /><br />He was treated with hyperbaric oxygen therapy, during which he developed tonic-clonic seizure activity, requiring urgent decompression and intubation. Repeat head CT remained negative. He later developed distributive shock after the seizure, required vasopressor support, and was managed in the ICU until stabilization. His neurologic weakness improved somewhat, and he was ultimately discharged to a nursing facility in stable condition.<br /><br />The report emphasizes that air embolism is a rare but life-threatening complication of lung biopsy, with risk increased by factors such as COPD, longer needle path, subpleural lesions, coughing, prone positioning, and certain needle angles. Because outcomes depend heavily on early recognition and treatment, clinicians should maintain a high index of suspicion and act quickly when air embolism is possible.

Asset Subtitle

Muhammad Hassaan Sattar

Meta Tag

Author List Muhammad Hassaan Sattar

Category Clinical Vignettes

Concept Pulmonary Artery Air Embolism

Concept Hyperbaric Oxygen Therapy

Concept Transthoracic Lung Biopsy

Concept Arterial Air Embolism

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Hattiesburg Clinic/Forrest General Hospital

Presenting Author Muhammad Hassaan Sattar

Track Adult

Keywords

CT-guided lung biopsy

cerebral air embolism

systemic air embolism

lung nodule biopsy

acute neurologic deficit

hyperbaric oxygen therapy

right-sided weakness

metastatic renal cell carcinoma

ICU management

biopsy complication

Pulmonary Artery Air Embolism

Hyperbaric Oxygen Therapy

Transthoracic Lung Biopsy

Arterial Air Embolism

Neurologic Deficit