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Cerebral air embolism following transbronchial lung biopsy during flexible bronchoscopy.

Evison M, Crosbie PA, Bright-Thomas R, Alaloul M, Booton R - Respir Med Case Rep (2014)

Bottom Line: A subsequent computed tomography brain scan confirmed cerebral air emboli.Increased airway pressure, caused by the patient exhaling against a bronchoscope wedged within a segmental bronchi, may subsequently force air bubbles through the vessel wall defects.This may explain the occurrence of air emboli.

View Article: PubMed Central - PubMed

Affiliation: North West Lung Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe M23 9LT, UK ; The Institute of Inflammation and Repair, The University of Manchester, UK.

ABSTRACT
During a diagnostic flexible bronchoscopy an 84 year old patient suffered a sudden reduction in conscious level following a transbronchial lung biopsy. A subsequent computed tomography brain scan confirmed cerebral air emboli. The patient survived following a period of supportive treatment in the critical care unit. Transbronchial lung biopsy may cause disruption of vessels walls within the lung parenchyma. Increased airway pressure, caused by the patient exhaling against a bronchoscope wedged within a segmental bronchi, may subsequently force air bubbles through the vessel wall defects. This may explain the occurrence of air emboli. This is a rare report of air embolism complicating transbronchial lung biopsy and all bronchoscopists should aware of this potentially fatal complication.

No MeSH data available.


Related in: MedlinePlus

Computed tomography brain demonstrating cerebral air emboli.
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fig2: Computed tomography brain demonstrating cerebral air emboli.

Mentions: An 84 year old lady was referred to the rapid access chest clinic for investigation of weight loss and an abnormal chest X-ray (CXR). An apical segment right upper lobe mass with a communicating segmental bronchus was confirmed on thoracic CT (Figure 1). Flexible bronchoscopy was performed under conscious sedation with incremental doses of midazolam (total 2 mg) and alfentanyl (total 250 mcg). As expected, no endobronchial abnormality was detected. TBLB was performed from the apical segment of the right upper lobe, with the bronchoscope positioned in the segmental bronchus. Following the second biopsy, the patient became unresponsive (Glasgow Coma Scale (GCS) = 3) with signs of upper airways obstruction requiring airway management and administration of high flow oxygen. Sedation was reversed with naloxone and flumazenil with no change in neurological status. A CXR confirmed the absence of a pneumothorax and a 12-lead electrocardiogram showed no acute changes. Haemodynamic stability was maintained throughout. The patient was transferred to the critical care unit where intravenous anticonvulsants were required to control multiple seizures. Improvement in GCS occurred over the next 48 h although a residual right hemiparesis (power 3/5) was evident. A CT brain scan, performed two hours following the deterioration, demonstrated small, rounded and black lucencies at the grey–white interface, confirming the diagnosis of cerebral air embolism (Figure 2). The patient was discharged 10 days later to a community rehabilitation unit.


Cerebral air embolism following transbronchial lung biopsy during flexible bronchoscopy.

Evison M, Crosbie PA, Bright-Thomas R, Alaloul M, Booton R - Respir Med Case Rep (2014)

Computed tomography brain demonstrating cerebral air emboli.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061444&req=5

fig2: Computed tomography brain demonstrating cerebral air emboli.
Mentions: An 84 year old lady was referred to the rapid access chest clinic for investigation of weight loss and an abnormal chest X-ray (CXR). An apical segment right upper lobe mass with a communicating segmental bronchus was confirmed on thoracic CT (Figure 1). Flexible bronchoscopy was performed under conscious sedation with incremental doses of midazolam (total 2 mg) and alfentanyl (total 250 mcg). As expected, no endobronchial abnormality was detected. TBLB was performed from the apical segment of the right upper lobe, with the bronchoscope positioned in the segmental bronchus. Following the second biopsy, the patient became unresponsive (Glasgow Coma Scale (GCS) = 3) with signs of upper airways obstruction requiring airway management and administration of high flow oxygen. Sedation was reversed with naloxone and flumazenil with no change in neurological status. A CXR confirmed the absence of a pneumothorax and a 12-lead electrocardiogram showed no acute changes. Haemodynamic stability was maintained throughout. The patient was transferred to the critical care unit where intravenous anticonvulsants were required to control multiple seizures. Improvement in GCS occurred over the next 48 h although a residual right hemiparesis (power 3/5) was evident. A CT brain scan, performed two hours following the deterioration, demonstrated small, rounded and black lucencies at the grey–white interface, confirming the diagnosis of cerebral air embolism (Figure 2). The patient was discharged 10 days later to a community rehabilitation unit.

Bottom Line: A subsequent computed tomography brain scan confirmed cerebral air emboli.Increased airway pressure, caused by the patient exhaling against a bronchoscope wedged within a segmental bronchi, may subsequently force air bubbles through the vessel wall defects.This may explain the occurrence of air emboli.

View Article: PubMed Central - PubMed

Affiliation: North West Lung Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe M23 9LT, UK ; The Institute of Inflammation and Repair, The University of Manchester, UK.

ABSTRACT
During a diagnostic flexible bronchoscopy an 84 year old patient suffered a sudden reduction in conscious level following a transbronchial lung biopsy. A subsequent computed tomography brain scan confirmed cerebral air emboli. The patient survived following a period of supportive treatment in the critical care unit. Transbronchial lung biopsy may cause disruption of vessels walls within the lung parenchyma. Increased airway pressure, caused by the patient exhaling against a bronchoscope wedged within a segmental bronchi, may subsequently force air bubbles through the vessel wall defects. This may explain the occurrence of air emboli. This is a rare report of air embolism complicating transbronchial lung biopsy and all bronchoscopists should aware of this potentially fatal complication.

No MeSH data available.


Related in: MedlinePlus