Massive gas embolism during pulmonary nodule hook wire localization

The locaization of pulmonary nodules by the hook wire technique has allowed accurate resection of small and nonsuperficial pulmonary nodules by video-assisted thoracoscopic surgery. Hook wire localization has been shown efficacious and safe with principal complications limited to pneumothorax, wire dislocation, and localized intrapulmonary hemorrhage. We report a case of massive gas embolism complicating this procedure. The probable causative mechanisms and possible methods for avoidance are discussed.