title: Delayed presentation of cerebellar and spinal cord infarction as a complication of computed tomography-guided transthoracic lung biopsy: a case report.
abstract: BACKGROUND
  Computed tomography-guided transthoracic needle biopsy is a common diagnostic procedure that is associated with various complications including pneumothorax, parenchymal hemorrhage, and hemoptysis. A systemic air embolism is a very rare (0.06 to 0.21%) but potentially fatal complication.
  
  
  METHODS
  A 70-year-old Korean male was admitted to our hospital for evaluation of a solitary pulmonary nodule located adjacent to the right inferior pulmonary vein in the medial basal segment of the right lower lobe. A computed tomography-guided needle biopsy was performed by a radiologist using a coaxial needle. A computed tomography image obtained immediately after the biopsy showed intraluminal free air in the proximal ascending aorta. He complained of a mild electrical current sensation in both lower extremities. After three hours he complained of neurological deficit in both lower extremities as well as voiding difficulty. The brain and spine magnetic resonance images showed a right cerebellar and spinal cord infarction at the T8-10 levels.
  
  
  CONCLUSIONS
  We report a case of air embolism to the cerebellum and spinal cord causing infarction presenting with an initial symptom of mild electrical current sensation in both lower extremities during the transthoracic needle biopsy. For this potentially fatal complication, early recognition, followed by prompt therapy is critical to reducing morbidity and mortality.
authors.forename: Kyung Min
authors.initials: KM
authors.lastname: Shin
authors.affiliation: Department of Radiology, Kyungpook National University, School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, South Korea. limjaekwang@gmail.com.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Lim
authors.forename: Chang-Ho
authors.initials: CH
authors.lastname: Kim
mesh_terms: D000368:Aged; D002526:Cerebellar Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D004618:Embolism, Air / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D007238:Infarction / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
references.citation: Acta Radiol Diagn (Stockh). 1976 Nov;17(6):813-28
references.pmid: 1016505
references.citation: Intensive Care Med. 2002 May;28(5):559-63
references.pmid: 12029402
references.citation: AJR Am J Roentgenol. 2009 Nov;193(5):W430-6
references.pmid: 19843723
references.citation: Chest. 2007 Aug;132(2):684-90
references.pmid: 17699141
references.citation: Cardiovasc Intervent Radiol. 2005 Jan-Feb;28(1):131-4
references.pmid: 15602640
references.citation: AJR Am J Roentgenol. 2004 Jun;182(6):1606-7
references.pmid: 15150026
references.citation: AJR Am J Roentgenol. 2002 Jun;178(6):1400-2
references.pmid: 12034605
references.citation: Ann Emerg Med. 2001 Nov;38(5):592-5
references.pmid: 11679875
references.citation: Eur J Radiol. 2006 Jul;59(1):60-4
references.pmid: 16530369