Coronary Air Embolism and Cardiogenic Shock During Computed Tomography-Guided Needle Biopsy of the Lung

Abstract

In a 77-year-old man with apical hypertrophic cardiomyopathy and nonsustained ventricular tachycardia, a pulmonary nodule in the right middle lobe was incidentally detected on a chest computed tomography (CT), which was performed for screening purposes of the interstitial pneumonia as a side effect of amiodarone. To establish the diagnosis of lung cancer, the patient was admitted to undergo a CT-guided transthoratic needle biopsy of the lung. The procedure was performed by an experienced pulmonologist using the 18-gauge outer coaxial needle of a disposable core biopsy instrument under CT guidance. The patient was placed in a supine position for the procedure. The biopsy needle was advanced into the lesion, and a specimen was successfully obtained (Figure 1A). Immediately after removing the biopsy needle followed by a postprocedure CT, the patient coughed, discharged a small amount of bloody phlegm, and developed chest pain. Then, he lost consciousness and developed shock with severe hypotension and decreased oxygen saturation. After he was administered 100% oxygen through a mask and received a large quantity of hydration, a chest CT was obtained again for suspected pulmonary hemorrhage …