[Systemic air embolism caused by CT-guided percutaneous lung puncture localization: a case report].
Liang Y, Liu X, et al. • Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases • 2026
Systemic air embolism causing sudden loss of consciousness and cardiac arrest occurred within one minute of CT-guided percutaneous lung puncture localization, with the complication related to gas entering the blood circulation especially when the puncture path was close to pulmonary vein branches.
Key Findings
Results
A 44-year-old male patient developed sudden loss of consciousness and cardiac arrest within one minute after CT-guided percutaneous lung puncture localization for a pulmonary nodule.
The patient was scheduled for minimally invasive surgery due to pulmonary nodules found on physical examination
Preoperative CT-guided percutaneous lung puncture localization was being performed at the time of the event
Cardiac arrest occurred approximately one minute after positioning of the pulmonary nodule
The event represents a rare but life-threatening complication of a commonly performed pre-surgical procedure
Results
Rapid CT imaging revealed pericardial and left ventricular gas shadows, confirming the diagnosis of systemic air embolism.
Gas shadows were identified in both the pericardium and the left ventricle on emergency CT scan
The presence of gas in the left-sided cardiac chambers indicates arterial (systemic) air embolism, as opposed to venous embolism
The puncture path being close to pulmonary vein branches was identified as a key risk factor for gas entry into the circulation
Air embolism was attributed to gas entering the blood circulation during the puncture procedure
Results
The patient was successfully resuscitated with cardiopulmonary resuscitation and subsequently recovered after advanced life support in the intensive care unit.
Immediate interventions included placing the patient in a supine position and initiating cardiopulmonary resuscitation
Following successful resuscitation, the patient was transferred to the intensive care unit for advanced life support
The patient's symptoms gradually improved over time
The patient was discharged after clinical stabilization
Discussion
The risk of air embolism during lung puncture is particularly elevated when the puncture path is close to pulmonary vein branches.
Gas entry into the blood circulation during puncture was identified as the mechanism of air embolism
Proximity of the puncture path to pulmonary vein branches was specifically highlighted as increasing risk
Pulmonary veins carry oxygenated blood directly to the left heart, providing a direct route for air to enter the systemic arterial circulation
The authors reviewed relevant literature in conjunction with this case report
Conclusions
The authors conclude that clinicians must maintain high vigilance for air embolism and other serious complications when performing lung puncture, and strengthen postoperative monitoring.
Systemic air embolism is identified as a serious complication of CT-guided percutaneous lung puncture localization
The case highlights the need for timely treatment to ensure patient safety
Enhanced postoperative monitoring is recommended following lung puncture procedures
Immediate recognition and response were critical to the patient's survival in this case
What This Means
This research describes a case report of a serious complication that occurred during a routine pre-surgical procedure. A 44-year-old man was having a small lung nodule marked with a needle under CT scan guidance — a common preparation step before minimally invasive lung surgery — when he suddenly lost consciousness and went into cardiac arrest within just one minute. Emergency CT scans revealed air bubbles trapped in and around his heart, a condition called systemic air embolism, where air accidentally enters the bloodstream and blocks blood flow. The air likely entered the circulation through pulmonary veins (blood vessels near the area being punctured), allowing it to travel directly to the heart and systemic circulation.
The medical team responded immediately with CPR, successfully revived the patient, and transferred him to intensive care. He gradually recovered and was eventually discharged from the hospital. The case documents that even routine preparatory procedures for lung surgery carry a risk of sudden, life-threatening complications.
This research suggests that doctors performing needle localization procedures in the lungs should be highly alert to the possibility of air embolism, particularly when the needle path passes near pulmonary vein branches. The case underscores the importance of having emergency response capabilities immediately available during these procedures and maintaining close monitoring of patients afterward, as rapid recognition and treatment were essential to this patient's survival.
Liang Y, Liu X, Zhang L, Wang D, Di D, Xie N. (2026). [Systemic air embolism caused by CT-guided percutaneous lung puncture localization: a case report].. Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases. https://doi.org/10.3760/cma.j.cn112147-20260215-00094