Arterial air embolism during percutaneous pulmonary marking under computed tomography guidance

Percutaneous pulmonary marking under computed tomography (CT) guidance is often used to identify the location of small nodules prior to pulmonary wedge resection by video assisted thoracoscopic surgery. Although pneumothorax and pulmonary hemorrhage are known complications that accompany this method, arterial air embolism is an extremely rare and occasionally fatal complication. We report a case of arterial air embolism during percutaneous pulmonary marking under CT guidance. Percutaneous pulmonary marking was performed in the prone position in a 59-year-old male with a right lung nodule. The chest CT performed immediately after this procedure revealed an air-fluid level in the heart. The skin of the patient’s back appeared cyanotic and neurological dysfunction was noted in his left thigh, although his vital signs were stable. Four hours later, the air in the heart and aorta disappeared, as observed by a chest CT. The patient underwent pulmonary resection 12 days later.