A FATAL CASE OF CEREBRAL-ARTERY GAS EMBOLISM FOLLOWING FINE-NEEDLE BIOPSY OF THE LUNG

Objectives: To report a case of cerebral artery gas embolism (CAGE), following fine needle biopsy of the lung, and to discuss the pathophysiology and treatment. Clinical features: A 65-year-old woman presented to an emergency department with the clinical features of a right thromboembolic stroke following a fine needle biopsy of the lung. Interventions and outcome: Computed tomography (CT) was performed after an unexpected deterioration in the woman's condition. The CT demonstrated the presence of intracranial translucencies consistent with CAGE. Hyperbaric oxygen therapy was initiated but, despite two courses, the woman's condition continued to deteriorate and she died two days later. Conclusion: CAGE is a known but little appreciated complication of fine needle biopsy of the lung, and may be clinically indistinguishable from thromboembolic strokes. Successful treatment is dependent on early recognition and application of hyperbaric oxygen therapy, which appears to protect against injury and reverse many of the pathological changes associated with CAGE. The increasing popularity of fine needle biopsy of the lung as an outpatient procedure is likely to result in further presentations with CAGE to emergency departments.