Emergency management of cerebral air gas embolism as a complication of CT-guided lung biopsy

Abstract Cerebral arterial gas embolism is a rare complication of percutaneous CT-guided lung biopsy i.e. associated with seizures and neurological deficits such as stroke. Failure to promptly recognise and urgently treat can lead to a very poor prognosis. This case describes an 80-year-old woman undergoing a CT-guided lung biopsy for histological assessment of a suspected malignant cavitating lung lesion. Shortly after the procedure, the patient developed complete left-sided hemiparesis. A CT scan of the head demonstrated air in the right middle cerebral artery territory. Urgent transfer to a specialist centre for gold standard hyperbaric oxygen therapy was critical to optimise patient recovery. To prevent further air migration, the patient was placed in the Trendelenburg and left lateral decubitus position and high flow oxygen was administered, while awaiting transfer. Following hyperbaric oxygen therapy, the patient was stepped down to a stroke unit for rehabilitation. Full neurological recovery was made. This case highlights that radiologists should be well-versed in recognising the signs and immediate management of air embolism and anticipate it as a rare but severe complication of lung biopsy.