Massive Air Embolism After Lung Biopsy

A 69-year-old man presented with pneumogenic sepsis. A chest radiograph showed bilateral extensive infiltrates that did not respond to broad-spectrum antibiotic treatment. Progressive respiratory failure necessitated invasive mechanical ventilation (bilevel positive airway pressure, 0.5 inspiratory oxygen saturation; peak inspiratory pressure, 24 cm H2O; positive end-expiratory pressure, 8 cm H2O). Chest computed tomography (CT) revealed inflammatory infiltrates with caverns and bilateral pleural effusions. Blood and bronchoalveolar cultures remained sterile. Therefore, computed tomography-guided lung biopsy was performed with an 18-gauge core needle with the patient in prone position (Figure, A). A control computed tomography scan (Figure, B) revealed massive systemic air embolism. Shortly thereafter, the patient developed cardiorespiratory failure. Cardiopulmonary resuscitation remained unsuccessful. Figure. A , Computed tomography-guided lung biopsy of infiltrates was performed with an 18-gauge needle and the patient in prone position. B , Air embolism after lung biopsy involving intercostal arteries (arrow), coronary arteries (arrowheads), and the aorta (white asterisk). Percutaneous computed tomography-guided lung biopsy is a frequently performed procedure for histological and microbiological analyses of pulmonary …