A cautious approach for detecting and managing intercostal artery injury during CT-guided lung biopsy: a case report and literature review

Intercostal artery (ICA) injury during CT-guided percutaneous transthoracic needle biopsy (PTNB) is a rare but potentially severe complication. This case report describes a cautious approach for detecting and managing suspected ICA injury using a coaxial needle system. During PTNB in a 71-year-old male with lung cancer, ICA injury was detected through blood aspiration during needle withdrawal. Management involved immediate cessation of withdrawal, slight needle advancement for mechanical hemostasis, and serial monitoring, achieving hemostasis without requiring additional invasive interventions. Literature review of cases from 2018 to 2024 revealed that current management approaches vary based on severity, with a 30% mortality rate among reported cases. Most ICA injuries are detected post-procedurally rather than intraoperatively. Traditional interventions range from conservative treatment to transcatheter arterial embolization (TAE) or thoracotomy. This approach suggests a potential stepwise method for managing suspected ICA injury that might reduce complications and minimize the need for invasive interventions. As a single case report representing hypothesis-generating evidence, this observation requires further validation through collaborative experience from other operators when similar circumstances arise. The case demonstrates an exploratory approach for managing ICA injury during PTNB, particularly relevant in resource-limited settings where interventional radiology services may not be immediately available.