Risk Factors for Systemic Air Embolism as a Complication of Percutaneous CT-guided Lung Biopsy: Multicenter Case-control Study

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.