CT引导下肺穿刺活检术并发体循环空气栓塞的研究进展

CT引导下肺穿刺活检术是肺部、纵隔疾病常用的确诊方法,气胸、出血是其常见并发症,一般病情进展缓慢,具有自限性;而体循环空气栓塞则极少见,但具有潜在的致命性,其发病急、症状重、致死率高,临床医师及放射科医师均应提高对此罕见并发症的认识.综述CT 引导下肺穿刺活检术并发体循环空气栓塞的相关研究进展.     

CT引导下肺穿刺活检继发动脉系统空气栓塞1例

<正>1临床资料患者男,70岁。因“胸闷、咳嗽2月余,痰中带血1 d”入院。胸部CT示轻度肺气肿,右肺中叶见一软组织密度肿块约4.8 cm,中度强化,可见分叶。为明确肿块性质,拟行CT引导下穿刺活检。患者取仰卧位,采用18 G一次性活检穿刺针和BARD全自动活检枪,活检枪切割长度设置为2 cm,     

1例CT引导下肺穿刺活检继发空气栓塞形成

1 临床资料 患者男,60岁,因“体检发现右肺占位性病变3d”入院,3d前在当地县医院体检发现右肺占位性病变,无咳嗽、咯痰及咯血,无低热、盗汗等结核中毒症状.既往有肺结核病史45年,为进一步治疗于2016年6月28日入住我院.     

CT引导下经皮肺穿刺活检方法改进初探

CT引导下经皮肺穿刺活检是目前胸部疾病诊断和鉴别诊断的重要手段,对于获取肺部病变的病理学诊断,具有较高的准确性,本研究旨在改进CT引导下经皮肺穿刺活检方法,以提高病理诊断率、减少并发症。     

CT引导下经皮肺穿刺活检的临床意义

目的：讨论总结CT引导下经皮肺穿刺活检术的临床应用及结果分析，探讨其意义。方法：采用GE-Hispeed螺旋CT机，各种型号病理穿刺针及切割针对36例胸部占位性病变，实施CT引导下经皮穿刺活检术。结果：病灶直径1．5-10cm大小，平均3．5cm。穿刺成功35例，活检阳性率100％，并发症有气胸3例，咯血1例，术后经抗炎及止血处理，气胸很快吸收。咯血停止。结论：CT引导下经皮肺穿刺活检术成功率高，并发症少而轻，对胸部占位性病的定性诊断具有重要的临床意义。     

套管内自体血注入法减少CT引导下经皮肺、纵隔穿刺活检术气胸的研究

【摘要】　目的?探讨采用套管内自体血注入法降低CT引导下经皮肺、纵隔穿刺活检术气胸并发症的发生率的可行性和安全性。方法?选取解放军第971医院肿瘤科137例肺、纵隔占位病变患者为观察组（A组）,胸外科和呼吸科共112例肺、纵隔占位病变患者为对照组（B组）。A组患者行CT引导下经皮肺、纵隔穿刺活检后套管内自体血注入法封闭脏层胸膜和肺组织创口,B组患者单纯行CT引导下经皮肺、纵隔穿刺活检术。分析两组患者气胸并发症的发生率、严重程度,并观察A组患者注入自体血后的不良反应。结果?两组患者穿刺活检全部成功;A组患者气胸发生率为7.3%（10/137）,B组患者气胸发生率为21.4%（24/112）,差异有统计学意义（P＜0.05）;气胸的发生与肺气肿、病变直径相关 （P＜0.05）;轻度气胸与套管内自体血注入法的发生相关（P＜0.05）;A组患者注入自体血后2例出现刺激性咳嗽且有少量咯血,无其他不良反应。结论?套管内自体血注入法可降低CT引导下经皮肺、纵隔穿刺活检术气胸并发症的发生率,安全性高。     

CT引导下经皮肺穿刺活检术并发症的影响因素分析

目的探讨CT定位下经皮肺穿刺活检术并发症发生的影响因素。方法 CT引导下应用意大利PRECISA 18 G切割针对110例患者行经皮肺穿刺活检术,将患者的年龄、性别、病灶大小、切割组织块的多少、穿刺胸膜次数、穿刺时间、病灶深度、病灶周围炎症、慢性肺部病变等相关因素分为不同等级资料,卡方分析不同等级资料之间并发症发生率有无差异性,Logistic回归分析并发症发生的独立危险因素。结果 110例患者术后出现出血28例(占25.5%),气胸27例(占24.5%),卡方分析显示术后出血在病灶大小、病灶深度、穿刺时间及病灶周围炎症之不同组别之间存在差异性(P<0.05);术后气胸在穿刺胸膜次数、穿刺时间、病灶深度、慢性肺部病变之不同组间之间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示病灶大小、病灶深度、病灶周围炎症在出血并发症中具独立危险因素,穿刺时间、穿刺胸膜的次数、慢性肺部病变在气胸并发症中具独立危险因素。结论肺穿刺活检术并发症的发生与病灶大小、穿刺胸膜次数、穿刺时间、病灶深度、病灶周围炎症、慢性肺部病变等相关。     

基于Fisher判别构建CT引导下肺穿刺活检并发症的预测模型

【摘要】　目的?探讨基于机器学习算法的Fisher判别,初步构建CT引导下经皮肺穿刺活检（PTNB）并发症的预测模型。方法　回顾性分析227例CT 引导下PTNB的肺部肿块或结节,用前187例筛选并发症危险因素,纳入有统计学意义的指标,构建Fisher判别式,然后采用交叉核实法和后40例评估预测模型。结果?187例中出现并发症48例（25.7%）,主要为气胸29例（15.5%）和肺出血26例（13.9%）,其中包含有气胸合并肺出血7例（3.74%）。并发症的危险因素有病灶大小、合并肺气肿、病灶中心与膈面短径、穿刺深度、穿刺角度和穿刺次数,并设参数值:X1=病灶大小（0＞2 cm;1≤2 cm）、X2=合并肺气肿等（0=是;1=否）、X3=病灶中心距离膈面短径（0＞3 cm;1≤3 cm）、X4=穿刺深度（0≤5 cm;1＞5 cm）、X5=穿刺胸膜角度（0≤50°;1＞50°）、X6=穿刺时间（0≤20 min;1＞20 min）、X7=穿刺次数（0=1次;1≥2次）。所得并发症的非标准化Fisher判别公式为Z = 1.531X1+ 1.531X2+ 2.123X3 + 1.390X4 + 1.564X5 + 0.903X6 + 1.716X7 - 3.114,判别界值为0.514。预测模型的交叉核实法和40例实践测评的误判率分别是10.2%和7.5%,准确率为89.8%和92.5%,敏感度为85.4%和88.9%,特异度为91.4%和93.5%。 结论?Fisher判别模型可以用于辅助临床预测CT引导下PTNB并发症的发生概率。     

CT引导下经皮肺穿刺活检经验总结

目的：探讨CT导引下经皮肺穿刺活检的技术方法和影响诊断准确性的因素，防范并发症的心得。方法：回顾性分析36例肺内病变CT引导下经皮肺穿刺活检的技术方法，就如何提高穿刺准确性及影响诊断准确率的因素、防范并发症的心得进行讨论。结果：36例中，穿刺成功率100％，活检诊断准确率为30／36（83％）。3例发生轻度气胸。结论：CT引导下经皮肺穿刺活检术是安全的，可有效提高肺内病变的诊断准确性。但操作医生熟练的技术方法非常重要，并可以减少并发症的发生。     

Asymptomatic systemic air embolism after CT-guided percutaneous transthoracic needle biopsy

PurposeWe presented details and incidence of systemic arterial embolism (SAE) following a CT-guided percutaneous transthoracic needle biopsy (PTNB) and evaluated risk factors for SAEs.MethodsWe retrospectively evaluated 1014 PTNBs performed in our hospital from 2005 to 2017. SAE was identified in the pulmonary vein, left heart, coronary artery, and aorta by reviewing post-biopsy CT images. Limited post-biopsy CT scans only covering the region biopsied were available until the first case of SAE was identified (n = 503). Then, the entire thorax was scanned for further examination of SAE (n = 511). Eighteen-gauge automatic cutting needles were used in all procedures. When SAE was evident on post-biopsy CT, subsequent brain CT was performed in order to confirm the cerebral SAE.ResultsNine patients (0.89%) developed SAEs. In the univariate analyses, the location of the needle tip relative to the lesion (outside or inside of the lesion) as well as accompanying pulmonary hemorrhage were significant risk factors for SAEs (P = 0.021 and 0.036, respectively). Two patients developed neurological symptoms with cerebral SAEs, and one of these had sequelae. In seven asymptomatic SAEs with no cerebral SAE, four patients were retrospectively-diagnosed cases and three patients were detected on post-biopsy CT images. All seven of these patients had no sequelae.ConclusionThe incidence of SAE was higher than expected, due to radiologically detected asymptomatic SAEs. The location of the needle tip relative to the lesion and accompanying pulmonary hemorrhage were significant risk factors for the occurrence of SAEs. We proposed a guideline for treating asymptomatic SAEs.     

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.Coronary artery air embolism, a condition with a high mortality rate, mostly results from the iatrogenic introduction of gas bubbles into the bloodstream. Direct injection of air or gas into major arterial vessels during cardiac catheterisation or interventional radiological angiography has been reported; however, it also is a rare complication of CT-guided percutaneous transthoracic biopsy of the lung. In the literature, 19 possible causes for air embolism are listed [1]. Of these, two are generally accepted as the most probable causes: communication of the ambient air with a pulmonary vein via the biopsy needle, or development of a bronchial-venous fistula at the needle tract or site of the core sample. We report a case of air embolism in the aorta and right coronary artery resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of lung.     

Systemic arterial air embolism after percutaneous lung biopsy

Systemic arterial air embolism is a rarely encountered but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often suboptimally managed. This review was inspired by our own institutional experience and we use this to demonstrate that excellent outcomes from this complication can be seen with prompt treatment using hyperbaric oxygen chamber therapy, after initial patient stabilization has been achieved. Pathophysiology, clinical features, and risk factors are reviewed and misconceptions regards venous versus arterial air embolism are examined. An algorithm is provided for radiologists to ensure suspected patients are appropriately managed with more favourable outcomes.     

Nonfatal air embolism complicating percutaneous CT-guided lung biopsy and VATS marking: Four cases from a single institution

Systemic air emboli occur as a rare complication of percutaneous needle biopsy of the lung and video-assisted thoracoscopic surgery (VATS) marking.Here we present four cases of systemic air emboli from single institution and the imaging findings and embolism' kinetics using contrast-enhanced media during VATS color marking with indocyanine green. We suggest that early detection using routine whole-lung CT is required for asymptomatic patients with abnormal air. If abnormal air is found, we should keep the patient to the appropriate posture in order to prevent moving the air until it dissipates. Early detection of abnormal air can prevent severe complications.     

Fatal air embolism as a complication of CT-guided needle biopsy of the lung

A CT-guided needle lung biopsy carries a risk of potential air embolization. We present a rare case of air embolization after this procedure. Postmortem CT revealed air in the cerebral arteries and the left ventricle. This complication is extremely rare; however, it becomes fatal when it happens. Several points to prevent this fatal complication are discussed.     

Systemic air embolism after percutaneous transthorasic needle biopsy of the lung

Computed tomography (CT)-guided percutaneous transthoracic biopsy of the lung is a well-established diagnostic technique, but it can pose complications to the patients. Air embolism is one of the rarest but potentially fetal complications of this procedure. The authors report a fetal case of systemic and massive air embolism to the coronary and cerebral arteries after the performance of lung biopsy. Careful reviewing of the obtained CT images during the procedure may avoid a missing systemic air embolism and can immediately provide an adequate therapy also in asymptomatic patients. This extremely rare complication is an inevitable event and may happen in spite of appropriate experience and meticulous care.