CT-guided Lung Biopsy Research Articles

Diagnostic Difficulties in Differentiating Sarcoidosis from Tuberculosis

Distinguishing sarcoidosis from pulmonary tuberculosis can sometimes be a great challenge to physicians, especially in developing countries where there is high prevalence of tuberculosis. Both tuberculosis and sarcoidosis are granulomatous diseases, however, tuberculosis has a caseating granuloma as opposed to sarcoidosis, which present with non-caseating epithelioid cell granuloma. Due to the marked clinico-radiological similarity of these entities and high prevalence of tuberculosis, these patients receive repeated courses of anti-tubercular therapy (ATT) while lung damage continues to progress. Recently, a 51 year old man presented to the out-patient department at Firoz Specialist Hospital, with one year history of non-productive cough, on and off low grade fever, and 9 kg weight loss. He was on ATT for the past one month. He had a past history of pulmonary tuberculosis 15 years before, for which he had a complete course of ATT. Respiratory system examination revealed inspiratory crept throughout in the right lung. Laboratory investigations showed normocytic normochromic anemia, white blood count 7530/mm3, erythrocyte sedimentation rate 45 mm at the end of one hour. Sputum for acid fast bacilli was negative. Chest radiography showed inhomogeneous opacity with reticulations in the right upper-mid zone (perihilar region), as shown in Fig. 1. High resolution Computed Tomography (HRCT) of the thorax revealed a cavitatory lesion in the posterior segment of the right upper lobe with multiple nodules in the anterior segment of the upper lobe and the middle lobe (Fig. 2). It was also associated with thickening of the interlobular septa and peri-bronchovascular bundle. Radiological differential diagnosis would be tuberculosis, sarcoidosis and lymphangitis carcinomatosis. However, secondary reactivation of tuberculosis was strongly suspected considering both clinical and radiological (mainly the cavitatory lesion) findings. Computed tomography guided lung biopsy revealed the presence of non-caseating granulomas suggestive of sarcoidosis. The patient was treated with prednisolone 60 mg/day. Within 3 weeks, marked clinical improvement was seen. Steroid was gradually tapered over the period of 4 weeks. The patient remained asymptomatic during the next six months. Figure 1 Chest X-ray (PA)-shows reticulonodular opacity in right perihilar region. Figure 2 HRCT thorax- shows a thick walled cavitatory lesion with multiple nodules in right middle lobe along with thickening of interlobular septa and bronchovascular bundle. Also patch of consolidation seen in lingular lobe. Sarcoidosis is a multisystem disorder of unknown etiology, characterized by the presence of non-caseating granuloma.1 Non-specific constitutional symptoms such as fever, fatigue, malaise and weight loss are present in approximately one-third of patients. The chest radiograph usually shows hilar and mediastinal lymphadenopathy. Other characteristic findings include interstitial lung disease, or occasional calcification of affected lymph nodes. Most commonly, high resolution CT of the thorax shows thickening of bronchovascular bundles and perilymphatic distribution of nodules which represent the sarcoid granuloma. Clinical and radiological features of tuberculosis and sarcoidosis are quite overlapping and therefore, a diagnostic dilemma often persists. Exclusion of tuberculosis is important, particularly because corticosteroids form the mainstay of treatment for sarcoidosis. Cavity formation is common in tuberculosis and uncommon in sarcoidosis. Greiner et al. reported only 3% of cases with cavity formation.2 The diagnosis is established most securely when clinico-radiologic findings are supported by histologic evidence of widespread non-caseating granulomas.1 Recently, adding to the diagnostic difficulty, there are also several reports of coexistence of sarcoidosis and tuberculosis in the same patients.3

Ultra–low-dose Protocol for CT-guided Lung Biopsies

Purpose Computed tomography (CT) scans are a significant source of radiation to patients. It was hypothesized that technical success and complication rates would not be significantly changed by radically lowering the CT dose during lung biopsies with an ultra–low-dose (ULD) protocol. Materials and Methods A total of 100 consecutive patients aged 11–89 years who underwent biopsies of lung lesions were evaluated. Technical parameters were altered halfway through the study from the standard dose (140 kV localizing/100 kV subsequent guiding scans with auto-mA) to a ULD protocol (100 kV, 7.5 mAs) as part of a quality initiative. ULD studies were evaluated subjectively for image quality on a five-point scale. Patients' body mass indexes, total estimated radiation doses (dose–length product), technical success rates, and complications were compared between the standard-dose and the ULD groups. Results Average radiation dose was reduced from 677.5 mGy·cm for the standard-dose group to 18.3 mGy·cm for the ULD group ( P < .0001). In the ULD group, image quality was rated as adequate or better in 96% of cases. Pneumothoraces necessitating chest tube placements occurred in 10% and 6% of cases in the ULD and standard dose groups, respectively ( P = .715). Technical success rates of 92% and 98% were obtained in the ULD and standard dose groups, respectively ( P = .362). Conclusions Radiation dose to the chest during CT-guided percutaneous lung biopsies is reduced greater than 95% versus a standard protocol through the use of a ULD CT protocol without decreasing technical success or patient safety.

Abstract No. 30: Pneumothorax and pulmonary hemorrhage in CT-guided lung biopsy: Analysis of risk factors

Abstract No. 30: Pneumothorax and pulmonary hemorrhage in CT-guided lung biopsy: Analysis of risk factors

A Mass of Myxofıbrosarcoma In The Lung

Fibrosarcoma is a mesenchymal tumor constituted by malignant fibroblasts. Myxofibrosarcoma is one of the fibrosarcoma variants that mostly develops from dermal/subcutaneous tissues. The most common locations are the limbs, with rare occurrences in the chest, head, and neck. Since, to best of our knowledge, there is no such report in English literature, we hereby present a case of lung myxofibrosarcoma. A 47-year-old man who had chest pain for 4 months was admitted to our clinic. The chest X-ray revealed a homogeneous density in the left upper lung. His chest computed tomography (CT) scan showed a solid mass lesion of 52 x 58 mm in size at the apical segment of the left upper lobe. There was tumor invasion at the second and third ribs. CT-guided fine-needle tru-cut lung biopsy was performed. Histopathological evaluation result was high grade myxofibrosarcoma. Surgery was conducted. Myxofibrosarcoma is a surgically curable disease. However, local recurrences occur in 50% to 60% of the cases. Therefore, chemotherapy and/or radiotherapy is the suggested approach following surgery.

Abstract No. 28: The diagnostic yield of CT-guided percutaneous lung biopsy in solid organ transplant recipients

Abstract No. 28: The diagnostic yield of CT-guided percutaneous lung biopsy in solid organ transplant recipients

A comparative study on manual and coaxial automated percutaneous lung biopsy

To evaluate the difference in diagnostic accuracy and complication rate and operational procedures between manual and coaxial automated percutaneous lung biopsy under CT-guidance. Ninety-seven patients [aged from 19 - 87 (50 ± 17) years], with undiagnosed pulmonary lesions underwent CT-guided percutaneous lung biopsy from June 2006 to May 2010 in this hospital. The final diagnosis was confirmed by surgical pathology or clinical follow-up. Fifty-three patients (32 males and 21 females) underwent manual percutaneous lung biopsy, while 44 patients (29 males and 15 females) underwent percutaneous lung biopsy by using a coaxial automated biopsy device (biopsy gun). Biopsies were carried out by the same physician in all cases with the 18G vitesse needle made by optimed company in German. Biopsy guns made by the same company were used in coaxial automated biopsy group. The puncture point, angle and depth were set according to the CT images under the guidance by CT grating. Generally, the puncture was directed vertically towards the lesions closest to the chest wall. In the manual biopsy group, the diagnostic accuracy was 91% (48/53), the pneumothorax rate was 11% (6/53), and the hemorrhage rate was 15% (8/53), while in the coaxial automated biopsy group, they were 75% (33/44), 30% (13/44) and 27% (12/44), respectively. The diagnostic accuracy was higher while the pneumothorax rate was lower in the manual biopsy as compared to the coaxial automated biopsy group.

Mycobacterium mageritensePulmonary Disease in Patient with Compromised Immune System

<i>Mycobacterium mageritense</i>Pulmonary Disease in Patient with Compromised Immune System

Pulmonary Alveolar Microlithiasis

Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic disease characterized by microliths in the lungs which is usually asymptomatic and often diagnosed incidentally. Here we discuss a case of a young woman while evaluating for surgery presented with an abnormal chest X ray of bilateral diffuse nodular opacities. Patient was completely asymptomatic. High resolution CT scan revealed crazy paving pattern, black pleura sign, and pleural calcification typical findings of pulmonary alveolar microlithiasis. CT guided lung biopsy confirmed the diagnosis. Keyword: Black pleura sign; calcium deposition; crazy paving pattern; pulmonary alveolar microlithiasis DOI: 10.3329/jom.v12i1.6111J Medicine 2011; 12 : 55-57

Risk factors for complications of CT-guided lung biopsies

This study assessed the risk factors for pneumothorax and intrapulmonary haemorrhage after computed tomography (CT)-guided lung biopsies. CT-guided lung biopsies performed between January 2007 and July 2008 were retrospectively evaluated to select the study cohort. Whenever possible, emphysema was quantified by using dedicated software. Features related to the patient, the lesion and the needle and its intrapulmonary path were recorded, along with the pathology findings and operators' experience. The occurrence of pneumothorax and parenchymal haemorrhage was recorded. Univariate and multivariate statistical analyses were performed to assess the association between risk factors and complications. P values <0.05 were considered significant. In 157/222 of the procedures considered, complications were associated with small lesion size and length of the intrapulmonary needle path. Transfissural course and type of needle were associated with pneumothorax using univariate analysis, whereas transfissural course was associated with intrapulmonary haemorrhage using both univariate and multivariate analysis. Emphysema, nodule type, patient position, access site and needle diameter were not significant. Fine-needle aspirates and operator experience were significantly correlated with inadequate biopsy samples. The size of the lesion and the length of the intrapulmonary trajectory are risk factors for pneumothorax and parenchymal haemorrhage. The transfissural course of the needles is frequently related to pneumothorax and intrapulmonary haemorrhage, and the type of the needle is related to pneumothorax.

Cardiac Metastasis: A Rare Involvement of Primitive Neuroectodermal Tumour of the Lung

A 15 year-old adolescent was referred with 2 month history of worsening of breathlessness and haemoptysis. He also reported constitutional symptoms of fever, poor appetite and weight loss. The chest roentgenogram showed a massive right pleural effusion with apparent cardiomegaly. The cardiac silhouette over the right heart border was obliterated and the mediastinum was widened. Computed tomogram of the thorax showed a bulky heterogeneous mass in the right lung with extension to the heart. Subsequent CT guided lung biopsy revealed Primitive Neuroectodermal tumour (PNET). Here, we illustrate the clinical course of an aggressive pulmonary PNET with lethal cardiac metastasis.

C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Lung Biopsy: Usefulness in Evaluation of Small Pulmonary Nodules

The purpose of this study was to evaluate the usefulness of C-arm conebeam CT-guided percutaneous transthoracic lung biopsy of small (≤ 2 cm) lung nodules. Twenty-seven patients who underwent C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy of small (≤ 2 cm) lung nodules were enrolled in the study. The mean nodule size was 13 ± 4 mm in diameter. These lesions were divided into two groups according to size: 10 lesions 1 cm or smaller and 17 lesions larger than 1 cm. The diagnostic accuracy, sensitivity, and specificity in the two groups were compared by use of Fisher's exact test. Radiation dose in a female humanoid phantom was measured with radiophotoluminescent glass dosimeters. The average patient dose was calculated. Eighteen malignant (67%) and eight benign (30%) nodules and one (3%) indeterminate nodule were found. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94%, 89%, 94%, 89%, and 92%. The sensitivity, specificity, and accuracy were 100%, 75%, and 90% for the lesions 1 cm or smaller and 91%, 100%, and 94% for the lesions larger than 1 cm. The accuracy, sensitivity, and specificity did not differ significantly between the groups (all p > 0.05, Fisher's exact test). The average radiation dose among 27 patients was 4.6 mSv (range, 2.19-9.37). C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy is a useful diagnostic technique in the evaluation of small lung nodules.

Detection of epidermal growth factor receptor mutations in non-small cell lung cancer tumor specimens from various ways by denaturing high-performance liquid chromatography

背景与目的表皮生长因子受体(epidermal growth factor receptor, EGFR)是最重要的非小细胞肺癌(non-small cell lung cancer, NSCLC)治疗靶点，EGFR突变可预测酪氨酸激酶抑制剂(tyrosine kinase inhibitor, TKI)的疗效。DNA直接测序是检测EGFR突变最常用的方法，同时也作为突变检测的“金标准”，但该方法耗时较长、所需组织量较多且敏感性较低。变性高效液相色谱法是一种快速、自动化、高敏感性的突变检测方法，本研究旨在探讨变性高效液相色谱法(denaturing high-performance liquid chromatography, DHPLC)快速检测NSCLC肿瘤组织EGFR基因突变的诊断价值。方法通过检测已知按不同比例混合的野生型及突变型EGFR质粒DNA，评价DHPLC法的准确性和敏感性。选取经多种途径获取的83例NSCLC患者的冻存肿瘤组织，提取DNA并PCR扩增EGFR外显子19、21，用DHPLC法检测并与直接测序法进行比较。结果当突变型质粒与野生型质粒按1:100混合时，仍可被DHPLC法显著检出，而直接测序法仅可检出1:10水平。83例NSCLC组织标本中，DHPLC法检出22例EGFR突变(突变率26.51%)，3例直接测序法结果为野生型，余19例EGFR突变及61例野生型均与直接测序法结果相符。DHPLC法的敏感度为100%，特异度为95.31%，对经皮细针肺穿刺活检、淋巴结活检以及外科切除等途径获取的肿瘤样本均具有较高的敏感度、特异度。EGFR突变与性别、病理类型显著相关，与吸烟状态、年龄等无相关性。结论DHPLC法可作为NSCLC患者EGFR基因型的初筛方法。

CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance

We evaluated radiation doses, complication rates, and diagnostic accuracy for CT-guided percutaneous needle aspiration biopsy (NAB) procedures of pulmonary lesions performed with or without fluoroscopic guidance. A total of 142 patients were prospectively enrolled to receive CT-guided NAB with (Group I, n = 72) or without (Group II, n = 70) fluoroscopic guidance. Outcome measurements were patient and doctor radiation dose, and complication rate. Sensitivity, specificity and accuracy were calculated based on 123 NAB results. The mean estimated effective patient radiation dose was 6.53 mSv in Group I and 2.72 mSv in Group II (p < 0.001). The mean estimated effective doctor dose was 0.054 mSv in Group I and 0.029 mSv in Group II (p < 0.001). The complication rate was significantly different between the two groups (13.4% versus 31.4%, p = 0.012). Sensitivity, specificity and accuracy for diagnosing pulmonary lesions were 97.8%, 100% and 98.4% in group I and 95.3%, 100% and 89.5% in group II (p > 0.05). CT fluoroscopy-guided NAB of pulmonary lesions provides high diagnostic accuracy and can be performed with significantly fewer complications. However, radiation exposure to both patient and doctor were significantly higher than conventional CT-guided NAB.

CT Guided Lung Biopsies: An Audit Cycle

Aim To re-audit the practice of CT guided lung biopsies Standard British Thoracic Society guidelines Methods The present audit of CT guided lung biopsies has been undertaken to assess if changes in practice instituted following an initial audit in 2003/2004 has improved the diagnostic yield and impacted on the complication rate. Results 97 biopsies were carried out in 90 patients. The overall diagnostic rate was 85.6 % (66 true positive and 17 true negatives). There were 14 (14.4%) false negatives. 28 (28.9%) patients developed a pneumothorax and 6 patients (6.2%) required insertion of chest drain. Conclusion The overall diagnostic rate is within the BTS standard and is higher than the previous audit (85.6 % compared to 81 % in the previous audit). The number of biopsies performed has increased significantly. The complication rate for pneumothorax is higher than the BTS standard. The technique of biopsy has also changed with most biopsies now being core biopsies rather than fine needle aspiration (FNA).

A Lung Biopsy Tract Plug for Reduction of Postbiopsy Pneumothorax and Other Complications: Results of a Prospective, Multicenter, Randomized, Controlled Clinical Study

To evaluate the ability of an expanding hydrogel lung biopsy tract plug ("plug") to reduce rates of pneumothoraces and other complications associated with computed tomography (CT)-guided lung biopsy. A total of 339 subjects (mean age, 67 years) who underwent lung biopsy of indeterminate masses, without immediate postsample CT evidence of a pneumothorax, were randomized at 15 U.S. centers. Treatment subjects (n = 170) received a plug deployed through the coaxial needle just before the needle was removed. Control subjects (n = 169) did not receive a plug. The primary end point was defined as the absence of pneumothorax on chest radiographs at all three required postprocedure assessments (30- to 60-minute, 24-hour, 30-day); analysis was stratified by any smoking history and study site. A central laboratory performed blinded independent interpretation of the radiographs. Among the 287 subjects who completed all postprocedure assessments, significantly more treatment subjects than control subjects achieved the primary end point (127 of 150, 85% vs 95 of 137, 69%; P = .002). Among all 339 randomized subjects, the odds of achieving the primary end point were 4.4 times greater for nonsmokers than they were for smokers (95% confidence interval, 1.7, 11.0; P = 0.002); study site had no statistically significant effect. Compared with control subjects, treatment subjects had fewer pneumothoraces (30 of 170, 18% vs 53 of 169, 31%), fewer chest tubes placed (6 of 170, 4% vs 18 of 169, 11%), and fewer postbiopsy hospital admissions (16 of 170, 9% vs 23 of 169, 14%). The lung biopsy tract plug significantly reduced rates of pneumothorax in patients undergoing CT-guided lung biopsy. Rates of chest tube placement and postprocedure hospital admission were also reduced.

Computed Tomography–Guided Percutaneous Needle Biopsy of Indeterminate Pulmonary Pathology: Efficacy of Obtaining a Diagnostic Sample in Immunocompetent and Immunocompromised Patients

PurposeWe aimed to evaluate the efficacy of computed tomography (CT)–guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation. Patients and MethodsFrom January 2003 to September 2008, 262 patients (mean age, 59 years; range, 18-92 years) with pulmonary nodules or a mass of uncertain etiology and with indeterminate radiologic characteristics underwent CT-guided percutaneous lung biopsy. Patients with discordant clinical history and imaging findings or immunocompromised patients at risk for both etiologies were included. Specimens were submitted for both cytology and microbiology. ResultsOf the entire cohort, 166 patients (63.4%) had a nonmalignant process, and 96 patients (36.6%) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4%). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8%) and 75 patients (78.1%), respectively, a difference that was statistically significant (P = .0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P = .2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P = .002 and P = .06, respectively). ConclusionCT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes.

Pulmonary blastoma: One case report and review of the literature

Pulmonary blastoma (PB) is a rare lung tumor composed of immature epithelial and/or mesenchymal tissues whose features may resemble early embryological pulmonary structure. PB most commonly manifested as a solitary parenchymal mass without predilection for any lobe on chest radiograph and CT. These radiologic features are nonspecific and many primary or metastatic tumors of the lung could be included in differential diagnosis. The terms pulmonary blastoma and pleuropulmonary blastoma have been used interchangeably in previously reported cases. The World Health Organization differentiates PB from pleuropulmonary blastoma. Well-differentiated fetal adenocarcinoma is now included as a histological variant of adenocarcinoma and should not be regarded as a “monophasic” PB. To make a preoperative diagnosis of PB, It is important that multiple areas were sampled under CT-guided percutaneous lung biopsy with coaxial needle avoiding the necrosis area of lesion because the primitive blastematous cells that are diagnostic of PB may be localized rather than uniformly distributed. This report describes the case of a 19-year-old man with a PB treated by surgery. The pathology, clinical features, prognostic factors, and relevant problems in the treatment are reviewed.

Utility of 3-year torso CT and head imaging in asymptomatic patients with high-risk melanoma.

8594 Background: Patients (pts) with stage IIB to IIIC melanoma have a lifetime risk of melanoma related mortality of 30- 60%. By 3 years (yrs) from initial diagnosis, the risk of relapse in pts who remain disease free is decreased by 50%-75%. We sought to determine the utility and cost effectiveness of radiologic restaging of this pt population at the 3-yr follow-up (f/up) time point. Methods: In 2004, the BIDMC Cutaneous Oncology Program (COP) began obtaining torso CT scan and head imaging at the 3-yr f/up visit in all pts with stage IIB-IIIC melanoma who remained recurrence free. Chart review was performed on the 50 pts within the COP database who had undergone such restaging through 7/09. True positive (TP), false positive (FP) and normal scans were identified. Analysis of the cost of imaging and the cost of additional intervention for f/up of positive studies was performed, and a cost/diagnosis (TP) was calculated. Results: 25 head CT scans, 25 head MRIs, and 50 torso CTs were performed. One FP head CT and 5 abnormal torso CT scans (3 FP, 2 TP) were identified. FP and TP rates were 4/50 (8%); 2/50, (4%), respectively. The total cost including 3 yr f/up scans, additional imaging (1 repeat head CT, 2 chest CTs, 1 abdominal MRI) and diagnostic procedures (1 CT-guided lung biopsy (bx), one pelvic LN bx) was $600,406. The cost/diagnosis was $300,203. Both pts with TP scans developed symptomatic recurrence within weeks and died at 1 and 6.5 months after stage IV diagnosis. In the remaining 48 pts, at a median f/up of 14.5 months after the 3-yr f/up scan, 1 pt developed symptomatic stage IV disease and 1 developed local recurrence. Conclusions: In patients with stage IIB-IIIC melanoma who are asymptomatic and continuously disease free, extensive 3-yr f/up imaging appears to be of limited value. Two-thirds of abnormalities are FPs, and the cost of identifying a TP is > $300K/pt. Based on these findings, routine torso CT and head imaging of such pts is not recommended. Furthermore, given the low risk of recurrence beyond 3 yrs, it is likely that subsequent routine imaging would have similarly low utility. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Abraxis BioScience, Antigenics, Bayer, Genentech, Novartis, Onyx, Pfizer, Schering-Plough

The contribution of CT-guided transthoracic lung biopsy to the diagnosis of organising pneumonia

Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious. CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis.

Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy

CT-guided transthoracic lung biopsy is becoming a widely accepted procedure for the diagnosis of pulmonary lesions. The rate of severe complications following such a procedure has been reported. Of these complications, air embolism is the most likely to be fatal. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung. The patient died from underlying malignant disease 4 months later.