Silent Threats: Location-Based Insights and Management Strategies for Air Embolism After Percutaneous Lung Procedures

• Describe the mechanisms of systemic air embolism during lung biopsy and ablation.


•  Interpret periprocedural CT images of air embolism in various anatomical sites, including coronary arteries, and correlate them with clinical scenarios.


• Outline intraprocedural management strategies tailored to the location and clinical presentation of air embolism.

Systemic air embolism, a rare but serious complication of percutaneous lung procedures (0.02% to 0.06% incidence) {1, 2}, can cause ischemia or infarction, particularly in organs with limited collateral blood flow. Air enters the circulation through direct access to pulmonary veins during needle manipulation, inadvertent puncture of adjacent air-filled structures creating a fistula, or microbubble formation during thermal ablation {2}. Awareness of diverse clinical presentations, management, and outcomes is crucial for raising awareness and ensuring early detection of this potentially life-threatening event.


Clinical Findings/Procedure Details:

Six cases of air embolism following lung procedures will be presented, with CT images showing air in the pulmonary vein, right atrium, descending aorta, left atrium, left ventricle, and coronary arteries. Each case will be discussed in relation to its clinical presentation and outcome.

Management strategies will be reviewed based on the embolism’s location (Table 1), along with an exploration of risk factors and preventive measures to minimize the incidence of air embolism during lung procedures.


Conclusion and/or Teaching Points:

Managing systemic air embolism after lung procedures requires prompt, location-specific interventions to minimize risks. Early detection and intervention are critical to reducing morbidity and mortality.