Two cases of air embolism during percutaneous pulmonary marking under computed tomography guidance

Abstract

Recently, small pulmonary nodules have been frequently detected owing to the development of computed tomography (CT). Needle markers are often used because identifying such lesions during surgery is sometimes difficult. However, some cases of air embolism associated with this procedure have been reported. In our institution, CT-guided needle marking has been performed in 139 patients, and two cases of air embolism have occurred until now. We report these two cases of air embolism and discuss CT-guided marking. The first case, a 71-year-old woman, was admitted to the hospital for biopsy of a diffuse bilateral pulmonary reticulo-nodular shadow. CT-guided needle marking was performed to ensure the biopsy location. Soon after the marking, she lost consciousness, and cerebral air embolism was diagnosed by CT. The second case, a 72-year-old man, had a small pulmonary nodule in the right middle lobe of the lung along with a tumor-like shadow in the right lower lobe of the lung. CT-guided needle marking was performed for the detection of the small nodule. Immediately after marking, he suddenly complained of chest oppression, and a coronary artery air embolism was diagnosed by CT. The shadow of the air bubble was diminished on observation and resolved without any symptom in both cases. Air embolism may cause serious conditions, so the indication of CT-guided marking needs to be carefully decided upon.