Scientific Letter
Cerebral Air Embolism After CT-guided Lung Biopsy: A Case of Early Diagnosis and Successful Treatment
Embolismo aéreo cerebral tras una biopsia pulmonar guiada por CT: un caso de diagnóstico temprano y tratamiento exitoso
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The white arrow indicates the target lesion in the right upper lobe, in close proximity to the main fissure. (B) Chest CT during the biopsy. An 18-gauge Tru-Cut needle is successfully advanced through the target nodule under continuous CT-fluoroscopy guidance, as indicated by the white arrow. (C) Brain CT 19<span class="elsevierStyleHsp" style=""></span>min after the biopsy. The white arrows indicate air in the right superior frontal, precentral, central (A) and superior temporal (B) sulci, consistent with cerebral venous air embolism. (D) Brain CT 3 days after biopsy showing complete resorption of the air bubbles. The white arrowhead indicates the external ventricular derivation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francesca Piccoli, Ezio Lanza, Romano Fabio Lutman" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francesca" "apellidos" => "Piccoli" ] 1 => array:2 [ "nombre" => "Ezio" "apellidos" => "Lanza" ] 2 => array:2 [ "nombre" => "Romano Fabio" "apellidos" => "Lutman" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289619302182" "doi" => "10.1016/j.arbres.2019.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302182?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919303003?idApp=UINPBA00003Z" "url" => "/15792129/0000005500000011/v1_201911020900/S1579212919303003/v1_201911020900/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0300289619302194" "issn" => "03002896" "doi" => "10.1016/j.arbres.2019.03.020" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "2145" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2019;55:600-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 39 "formatos" => array:2 [ "HTML" => 24 "PDF" => 15 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta Científica</span>" "titulo" => "Linfoepitelioma-like primario pulmonar en paciente no asiático" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "600" "paginaFinal" => "601" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary Pulmonary Lymphoepithelioma-Like Carcinoma in a Non-Asian Patient" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 335 "Ancho" => 1405 "Tamanyo" => 211702 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Tinción de hematoxilina-eosina ×100, donde se observan áreas de clara diferenciación epitelial con citoplasmas amplios y eosinófilos, y muy abundantes linfocitos en el estroma. B) El estudio inmunohistoquímico es positivo para citoqueratina AE1/AE3. C) Llamativa positividad de todas las células epiteliales atípicas para EBER (VEB-encoded small nuclear RNA).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Llabrés de Prada, Roberto Martin-Deleon, Daniel Martinez, Carmen M. Lucena, Carles Agustí" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Llabrés de Prada" ] 1 => array:2 [ "nombre" => "Roberto" "apellidos" => "Martin-Deleon" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Martinez" ] 3 => array:2 [ "nombre" => "Carmen M." "apellidos" => "Lucena" ] 4 => array:2 [ "nombre" => "Carles" "apellidos" => "Agustí" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212919302630" "doi" => "10.1016/j.arbr.2019.03.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919302630?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302194?idApp=UINPBA00003Z" "url" => "/03002896/0000005500000011/v4_202003140718/S0300289619302194/v4_202003140718/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0300289619302170" "issn" => "03002896" "doi" => "10.1016/j.arbres.2019.03.019" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "2143" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2019;55:597-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 59 "formatos" => array:2 [ "HTML" => 41 "PDF" => 18 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Mucormycotic Pulmonary Pseudoaneurysm Causing Fatal Hemoptysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "597" "paginaFinal" => "598" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemoptisis letal causada por un pseudoaneurisma pulmonar mucomircótica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1500 "Tamanyo" => 252628 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior chest radiograph (A) showing three large cavitary lesions, two on the right lung and one on the left, with air-fluid levels. Coronal computed tomography image (B) obtained with the lung window setting demonstrating the thick-walled cavitary lesions, with solid content in one lesion on the right. Axial contrast-enhanced image (C) obtained with the mediastinal window setting depicting the solid content in the lower cavity, with a highly enhancing nodule inside (arrow), compatible with an aneurysm. Computed tomography–pulmonary angiography image (D) demonstrating that the pseudoaneurysm is related to a peripheral pulmonary artery (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luciana Volpon Soares Souza, Arthur Soares Souza, Edson Marchiori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luciana Volpon Soares" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Arthur Soares" "apellidos" => "Souza" ] 2 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212919303039" "doi" => "10.1016/j.arbr.2019.03.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919303039?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302170?idApp=UINPBA00003Z" "url" => "/03002896/0000005500000011/v4_202003140718/S0300289619302170/v4_202003140718/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Cerebral Air Embolism After CT-guided Lung Biopsy: A Case of Early Diagnosis and Successful Treatment" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "599" "paginaFinal" => "600" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francesca Piccoli, Ezio Lanza, Romano Fabio Lutman" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Francesca" "apellidos" => "Piccoli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ezio" "apellidos" => "Lanza" "email" => array:1 [ 0 => "eziolanza@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Romano Fabio" "apellidos" => "Lutman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Humanitas University, Pieve Emanuele, MI, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Humanitas Clinical and Research Center – IRCCS, Rozzano, MI, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolismo aéreo cerebral tras una biopsia pulmonar guiada por CT: un caso de diagnóstico temprano y tratamiento exitoso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1663 "Ancho" => 1733 "Tamanyo" => 206486 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT prior biopsy. The white arrow indicates the target lesion in the right upper lobe, in close proximity to the main fissure. (B) Chest CT during the biopsy. An 18-gauge Tru-Cut needle is successfully advanced through the target nodule under continuous CT-fluoroscopy guidance, as indicated by the white arrow. (C) Brain CT 19<span class="elsevierStyleHsp" style=""></span>min after the biopsy. The white arrows indicate air in the right superior frontal, precentral, central (A) and superior temporal (B) sulci, consistent with cerebral venous air embolism. (D) Brain CT 3 days after biopsy showing complete resorption of the air bubbles. The white arrowhead indicates the external ventricular derivation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic air embolism (SAE) is the rarest and most unpredictable complication of CT-guided lung biopsy, with an estimated incidence of 0.061–0.21%.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It may occur due to the formation of a transient broncho-venous fistula after needle penetration of the lung or inadvertent puncture of a pulmonary vein; furthermore, air can reach the venous circulation through the pulmonary microvasculature.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a> We report a case of cerebral air embolism after CT-guided lung biopsy, diagnosed according to the Hare et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> algorithm (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and treated in a hospital setting without a hyperbaric chamber. The outcome was positive, and the patient was discharged without permanent sequelae.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A 36 years old woman affected by Chron's Disease and Hodgkin Lymphoma, treated with allogeneic transplant, came to our attention for CT-guided biopsy of an FDG/PET-positive pulmonary nodule located in the right upper lobe, suspicious for lymphoma relapse (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After obtaining the informed consent and under local anesthesia, an 18-gauge Tru-Cut core biopsy needle (Argon Medical Devices, USA) was inserted under fluoroscopy-CT guidance through the right pectoral muscles. A specimen of the lesion was collected in a single shot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Immediately after needle removal, the patient experienced hemoptysis and had a tonic–clonic seizure. According to the abovementioned algorithm, the cardiac arrest team was called, 100% oxygen supply was started and both chest and brain CT were performed, 19<span class="elsevierStyleHsp" style=""></span>min after lung puncture. The brain CT showed mild cerebral edema and the presence of bilateral intracranial air, mainly located in the right frontal and parietal lobes, suggesting SAE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The patient was then moved to the right lateral decubitus and high flow oxygen was continued during its transfer to the intensive care unit. Neurological assessment scored 8 points in the Glasgow Coma Scale (Eyes<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2, Verbal<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2, Motor<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4), which prompted the placement of an external ventricular derivation to control the intracranial pressure. A drug-induced coma was maintained for 48<span class="elsevierStyleHsp" style=""></span>h. Upon awakening, the patient's vitals normalized, and the neurological deficits improved. The brain CT performed 3 days after the biopsy, showed complete resorption of the cerebral air bubbles and normal permeability of the main intracranial venous sinuses. She was discharged 10 days later, after complete recovery.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pulmonary biopsy was positive for secondary localization of lymphoma and the patient died 8 months later due to graft-versus-host disease.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this report, we showed how the use of the Hare et al. algorithm enabled a rapid diagnosis and quickened the decision-making treatment process. Our experience is limited to this single case; it is, however, important by virtue of cerebral SAE rarity and its life-threatening characteristics. In fact, most SAE reports describe cardiac and respiratory symptoms,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> whereas only a few describe neurological manifestations. As reported by Kim et al., even simple needle insertion into the chest wall can cause air to flow through the pulmonary venous circulation thus, piercing the lung parenchyma may not be the only maneuver at risk for SAE.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Our treatment course deviated from the recommendations previously described due to the absence of a hyperbaric chamber in our hospital and to the placement of a ventricular derivation, never reported before to treat SAE (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). This choice proved successful. It is in fact known that many forms of acute brain injury benefit from cerebrospinal fluid diversion and the continuous monitoring of intracranial pressure provided by the insertion of an external ventricular derivation which is one of the lifesaving procedures in the neurologic intensive care unit.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, physicians performing lung biopsies should be aware of the unpredictable manifestations of SAE and mindful of the usefulness of an emergency algorithm for its management.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1663 "Ancho" => 1733 "Tamanyo" => 206486 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT prior biopsy. The white arrow indicates the target lesion in the right upper lobe, in close proximity to the main fissure. (B) Chest CT during the biopsy. An 18-gauge Tru-Cut needle is successfully advanced through the target nodule under continuous CT-fluoroscopy guidance, as indicated by the white arrow. (C) Brain CT 19<span class="elsevierStyleHsp" style=""></span>min after the biopsy. The white arrows indicate air in the right superior frontal, precentral, central (A) and superior temporal (B) sulci, consistent with cerebral venous air embolism. (D) Brain CT 3 days after biopsy showing complete resorption of the air bubbles. The white arrowhead indicates the external ventricular derivation.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SUSPECTED ARTERIAL AIR EMBOLISM DURING LUNG BIOPSY \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SIGNS AND SYMPTOMS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiologist needs a high index of suspicion if fall in GCS; chest pain; facial drop; seizures \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial resuscitation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Call cardiac arrest team \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Turn patient on right lateral decubitus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High flow of 100% oxygen \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continued BP monitor, cardiac monitor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contact Hyperbaric oxygen chamber unit \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT brain and thorax in right lateral decubitus position \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continued resuscitation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Try to keep patient in a right lateral decubitus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High flow of 100% oxygen \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Once stabilized: Urgent transfer to the hyperbaric chamber \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuous high flow oxygen while awaiting transfer \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2259147.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An algorithm for the recognition and early management of suspected systemic arterial air embolism post-lung biopsy <span class="elsevierStyleItalic">(by Hare et al. Clin Radiol. 2011 Jul; 66(7) 589–596)</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Tomiyama" 1 => "Y. Yasuhara" 2 => "Y. Nakajima" 3 => "S. Adachi" 4 => "Y. Arai" 5 => "M. 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Golden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.165.2.3659355" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1987" "volumen" => "165" "paginaInicial" => "351" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3659355" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraventricular air embolism complicating computed tomography-guided pulmonary aspiration biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Dietrich" 1 => "A. Vargas" 2 => "D.E. Smith" 3 => "A. Domenech" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2016.09.002" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2017" "volumen" => "53" "paginaInicial" => "348" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28277229" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic arterial air embolism after percutaneous lung biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.S. Hare" 1 => "A. Gupta" 2 => "A.T.C. Goncalves" 3 => "C.A. Souza" 4 => "F. Matzinger" 5 => "J.M. Seely" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crad.2011.03.005" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "589" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21530954" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic air embolism after percutaneous lung biopsy: a manageable complication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Fiore" 1 => "N.E. Frenk" 2 => "G.L.P. Martins" 3 => "P.C.C. Viana" 4 => "M.R. de Menezes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3941/jrcr.v11i6.2990" "Revista" => array:6 [ "tituloSerie" => "J Radiol Case Rep" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "6" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29299093" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral air embolism following pigtail catheter insertion for pleural fluid drainage" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.I. Kim" 1 => "H.J. Kwak" 2 => "J.-Y. Moon" 3 => "S.-H. Kim" 4 => "T.H. Kim" 5 => "J.W. Sohn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Tuberc Respir Dis (Seoul)" "fecha" => "2013" "volumen" => "74" "paginaInicial" => "286" "paginaFinal" => "290" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "External ventricular drains: management and complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Muralidharan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2152-7806.157620" "Revista" => array:7 [ "tituloSerie" => "Surg Neurol Int" "fecha" => "2015" "volumen" => "6" "numero" => "Suppl. 6" "paginaInicial" => "S271" "paginaFinal" => "S274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26069848" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack454381" "titulo" => "Acknowledgments" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The authors wish to thank all the colleagues who contributed to the care of this patient, particularly Dr. Federico Barra for the brilliant management of the acute phase and Dr. Simona Marcheselli for the neurological assessment throughout the observation.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005500000011/v4_202003140718/S0300289619302182/v4_202003140718/en/main.assets" "Apartado" => array:4 [ "identificador" => "49741" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific Letters / Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005500000011/v4_202003140718/S0300289619302182/v4_202003140718/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302182?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 48 | 21 | 69 |
| 2024 September | 44 | 10 | 54 |
| 2024 August | 61 | 38 | 99 |
| 2024 July | 55 | 19 | 74 |
| 2024 June | 54 | 23 | 77 |
| 2024 May | 83 | 31 | 114 |
| 2024 April | 45 | 21 | 66 |
| 2024 March | 37 | 20 | 57 |
| 2024 February | 42 | 20 | 62 |
| 2023 March | 18 | 4 | 22 |
| 2023 February | 63 | 18 | 81 |
| 2023 January | 39 | 17 | 56 |
| 2022 December | 71 | 21 | 92 |
| 2022 November | 94 | 29 | 123 |
| 2022 October | 67 | 29 | 96 |
| 2022 September | 43 | 22 | 65 |
| 2022 August | 52 | 45 | 97 |
| 2022 July | 43 | 48 | 91 |
| 2022 June | 83 | 35 | 118 |
| 2022 May | 45 | 33 | 78 |
| 2022 April | 49 | 28 | 77 |
| 2022 March | 56 | 32 | 88 |
| 2022 February | 43 | 32 | 75 |
| 2022 January | 40 | 30 | 70 |
| 2021 December | 30 | 38 | 68 |
| 2021 November | 30 | 36 | 66 |
| 2020 October | 2 | 0 | 2 |
| 2020 May | 1 | 0 | 1 |
| 2020 April | 0 | 2 | 2 |
| 2020 March | 1 | 0 | 1 |
| 2020 February | 1 | 2 | 3 |
| 2020 January | 1 | 0 | 1 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 24 | 19 | 43 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 1 | 2 | 3 |
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