ABSTRACT
We present a case in which a hookwire that was used as a video-assisted thoracoscopic (VATS) surgery marker migrated into the splenic artery. The patient was a 70-year-old man with an 18-mm ground glass nodule (GGN) in the right S2. As the GGN was not located in the peripheral part of the lung, a percutaneous hookwire was placed as a marker under CT-guided just before the surgery. We performed VATS right S2 segmentectomy to remove the GGN and the marker; however, we could not locate the marker in the specimen. Histopathological examination revealed adenocarcinoma, TisN0M0, stage 0. CT findings after surgery showed that the marker had migrated into the splenic artery. We followed up the patient, and CT examination conducted 1, 3 and 6 months after the surgery showed no further migration and no damage of the splenic artery. We report the complication of percutaneous hookwire migration into a blood vessel.
Subject(s)
Adenocarcinoma/surgery , Foreign-Body Migration/etiology , Lung Neoplasms/surgery , Solitary Pulmonary Nodule/surgery , Splenic Artery/pathology , Thoracic Surgery, Video-Assisted/instrumentation , Aged , Biomarkers , Foreign-Body Migration/diagnostic imaging , Humans , Male , Radiography, Interventional , Splenic Artery/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To determine risk factors for systemic air embolism by percutaneous computed tomography (CT)-guided lung biopsy. METHODS: This case-control study used data from 2216 percutaneous lung biopsy procedures performed over 11 years at 12 institutions in Japan. Systemic air embolism was identified by retrospective review of CT images obtained during and immediately after the procedures. To fulfill our objective, multiple variables were compared between cases and controls with univariate analyses by using Student's t test and Fisher's exact test for numerical and categorical values, respectively. Multivariate logistic regression analysis was then performed using selected variables. RESULTS: Ten cases of systemic air embolism and 2,206 controls were identified. Univariate analyses showed that the lesions in the lower lobe (P = 0.025) and occurrence of parenchymal hemorrhage (P = 0.019) were significant risk factors. Multivariate analysis showed that the use of a larger biopsy needle was a significant risk factor (P = 0.014). CONCLUSION: Parenchymal hemorrhage during the procedure, lesions in the lower lobe, and the use of larger biopsy needles may be risk factors for systemic air embolism by percutaneous CT-guided lung biopsy. Our findings may provide clues toward minimizing the risk of this complication.
