title: Measures to Prevent Air Embolism in Transthoracic Biopsy of the Lung.
abstract: OBJECTIVE
  Systemic air embolism (AE) is a rare but feared complication of transthoracic biopsy with potentially fatal consequences. The aim of the study was to assess the effect of patient positioning during transthoracic biopsy on preventing systemic AE.
  
  
  METHODS
  We compared a historical control group of 610 patients (group 1) who underwent transthoracic biopsy before the implementation of measures to prevent systemic AE during transthoracic biopsy and a group of 1268 patients (group 2) who underwent biopsy after the measures were implemented. The patients in group 2 were placed in the ipsilateral-dependent position so that the lesion being biopsied was located below the level of the left atrium.
  
  
  RESULTS
  The rate of systemic AE was reduced from 3.77% to 0.16% (odds ratio [OR], 0.040; 95% CI, 0.010-0.177; p < 0.001). Logistic regression analyses identified needle penetration depth, prone position of the patient during biopsy, location above the level of the left atrium, needle path through ventilated lung, and intubation anesthesia as independent risk factors for systemic AE (p < 0.05). Propensity score-matched analyses identified the number of biopsy samples obtained as an additional risk factor (p = 0.003). The rate of pneumothorax was reduced from 15.41% in group 1 to 5.99% in group 2 (OR, 0.374; 95% CI, 0.307-0.546; p < 0.001).
  
  
  CONCLUSIONS
  Performing transthoracic biopsy with the patient in an ipsilateral-dependent position so that the lesion is located below the level of the left atrium is an effective measure for preventing systemic AE. Needle path through ventilated lung and intubation anesthesia should be avoided whenever possible.
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schönherr
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Freund
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Melanie
authors.initials: M
authors.lastname: Haslauer
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Petersen
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Loizides
authors.affiliation: 2 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Grams
authors.affiliation: 3 Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Augustin
authors.affiliation: 4 Department of Surgery, University Hospital for Anaesthesia and Intensive Care, Innsbruck, Austria.
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Wiedermann
authors.affiliation: 1 Department of Radiology, Medical University of Innsbruck, University Clinic-State Hospital of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rehwald
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects*; D003287:Contrast Media; D004618:Embolism, Air / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007479:Iopamidol; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: CT; interventional radiology; lung biopsy; systemic air embolism; transthoracic biopsy