title: Systemic air embolism causing acute stroke and myocardial infarction after percutaneous transthoracic lung biopsy - a case report.
abstract: The air embolism in this case was likely to have been caused by positioning the patient in a prone position, which was associated with the lesion to be biopsied being at a maximum height over the left atrium. Due to the resulting negative pressure, air entered through a fistula that formed between the airspace and the pulmonary vein. The air could have been trapped in the left atrium by positioning the patient in left lateral position. The event itself could have been prevented by positioning the patient in an ipsilateral dependent position during the biopsy. In addition to hyperbaric oxygen therapy, the preferred treatment options are positioning maneuvers, administration of pure oxygen, and heparinization.
authors.affiliation: Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rehwald
authors.affiliation: Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Loizides
authors.affiliation: Department of Surgery, University Hospital for Anesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Wiedermann
authors.affiliation: Department of Radiology, University Hospital for Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Grams
authors.affiliation: Department of Radiology, University Hospital for Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Djurdjevic
authors.affiliation: Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria. bernhard.glodny@i-med.ac.at.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004618:Embolism, Air / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications; D011187:Posture; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Air embolism; Intensive care; Myocardial infarction; Stroke; Transthoracic biopsy