Systemic air embolism is a rare but potentially catastrophic complication of percutaneous transthoracic needle lung biopsy. Systemic air embolism can occur as a result of placement of the biopsy needle tip into a pulmonary vein, thus entraining atmospheric air, or by the formation of bronchial-venous or alveolar-venous fistulous tracks. When pressure in the air containing spaces exceeds venous pressure (e.g., during coughing or positive pressure ventilation), embolization and entry of air into the left heart chambers can occur. Coronary and cerebral embolization can lead to cardiac and neurologic ischemia. A computed tomography scan in a 58-yr-old male who underwent a transthoracic needle lung biopsy in the prone position revealed air in the left atrium (arrow, panel A). Imaging in the right lateral decubitus position demonstrated air in the left ventricle and...

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