Our Summary

This paper is about a rare but potentially dangerous complication that can occur during a specific medical procedure. The procedure in question is a CT-guided percutaneous needle biopsy, which is a type of test where a small piece of tissue is removed from the body (in this case, the liver or lung) with the help of a CT scan for guidance. The complication is a cerebral air embolism, which is when an air bubble gets into the blood vessels of the brain.

This can be caused by various factors, including coughing, the use of positive pressure ventilation (a type of breathing assistance), incorrect positioning during the procedure, repeated attempts to perform the biopsy, having a cavity or cyst in the area being biopsied, or having inflamed blood vessels.

The researchers looked at a case where this happened during a liver biopsy, and also reviewed past cases where it happened during lung biopsies. They found that it’s important for doctors to correctly diagnose this complication when it happens and to treat it quickly. The main treatment currently used for this complication is hyperbaric oxygen therapy, which involves breathing pure oxygen in a pressurized room or tube.

FAQs

  1. What is a cerebral air embolism and how can it occur during a CT-guided percutaneous liver biopsy?
  2. What are the possible causes of cerebral air embolism during CT-guided liver or lung biopsy?
  3. What is the main treatment for cerebral air embolism after a liver biopsy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about liver biopsy is to avoid taking any blood thinning medications or supplements for a certain period of time before the procedure to reduce the risk of bleeding. It is also important to follow the fasting instructions given by the doctor before the biopsy to ensure accurate results. Additionally, the patient should inform the doctor of any allergies or medical conditions they have to ensure a safe procedure.

Suitable For

Patients who are typically recommended for a liver biopsy include those with:

  1. Abnormal liver function tests
  2. Suspected liver diseases such as hepatitis, cirrhosis, or fatty liver disease
  3. Liver tumors or masses
  4. Monitoring the progression of liver diseases
  5. Evaluating the effectiveness of treatment for liver diseases
  6. Assessing the extent of liver damage
  7. Determining the cause of unexplained liver abnormalities

It is important for clinicians to carefully assess the potential risks and benefits of a liver biopsy for each individual patient and to consider alternative diagnostic tests if necessary.

Timeline

Before liver biopsy:

  • Patient undergoes initial consultation with a healthcare provider who determines the need for a liver biopsy based on symptoms and diagnostic tests.
  • Patient may undergo blood tests, imaging studies (such as ultrasound, CT scan, or MRI), and other pre-operative evaluations to assess liver function and identify any potential risks.
  • Patient may receive instructions on fasting or medication adjustments before the procedure.
  • Patient signs consent form and is informed about the risks and benefits of the procedure.

During liver biopsy:

  • Patient is positioned on the examination table and the skin over the liver is cleaned and numbed with a local anesthetic.
  • A needle is inserted through the skin and into the liver to obtain a tissue sample.
  • Patient may experience some discomfort or pain during the procedure.
  • After the biopsy, pressure is applied to the biopsy site to stop any bleeding.
  • The tissue sample is sent to a laboratory for analysis.

After liver biopsy:

  • Patient is monitored for a period of time to check for any immediate complications, such as bleeding or infection.
  • Patient may experience some pain or discomfort at the biopsy site, which can usually be managed with over-the-counter pain medication.
  • Patient may be advised to avoid strenuous activities or heavy lifting for a certain period of time.
  • Results of the biopsy are usually available within a few days to a week, and the healthcare provider will discuss the findings with the patient and recommend any necessary follow-up care.

What to Ask Your Doctor

  1. What are the risks and potential complications of a liver biopsy, including the rare complication of cerebral air embolism?
  2. How often does cerebral air embolism occur as a complication of a liver biopsy?
  3. What measures will be taken to minimize the risk of cerebral air embolism during the biopsy procedure?
  4. What symptoms should I watch for after the biopsy that could indicate a complication like cerebral air embolism?
  5. How would cerebral air embolism be diagnosed and treated if it were to occur during or after the liver biopsy procedure?
  6. Are there any alternative imaging techniques or biopsy methods that could reduce the risk of cerebral air embolism in my case?
  7. Can you provide more information about the hyperbaric oxygen therapy that is used to treat cerebral air embolism, and what are the success rates of this treatment?

Reference

Authors: Sun D, Sui P, Zhang W, Zhang L, Xu H. Journal: J Cancer Res Ther. 2018;14(7):1650-1654. doi: 10.4103/jcrt.JCRT_1035_17. PMID: 30589054