BMJ Case Reports 2018; doi:10.1136/bcr-2017-222254
  • Unexpected outcome (positive or negative) including adverse drug reactions

Fatal air embolism following local anaesthetisation: does needle size matter?

  1. Shikha Gupta4
  1. 1Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
  2. 2Univeristy of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3Division of Pulmonary and Critical care medicine, University Hospitals/ Case Western University Hospital, Cleveland, OH, USA
  4. 4Division of Pulmonary and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  1. Correspondence to Faiza Khalid, Faizakhalid24{at}
  • Accepted 23 January 2018
  • Published 5 February 2018


A 76­-year­-old male cigarette smoker presented with a 2-week history of cough and haemoptysis. Chest CT on admission revealed multiple new lung nodules concerning for malignancy. CT-­guided biopsy of the nodule in left lower lobe was attempted in prone oblique position for tissue diagnosis. Local anaesthetic (lidocaine) was administered using a 25-­gauge (1.5-inch) needle to anaesthetise the skin and subcutaneous tissue. This was followed by insertion of a 25-gauge (3.5-inch) Whitacre needle to anaesthetise deeper tissues and parietal pleura. Due to patient’s coughing and proximity of the nodule to the diaphragm, the circumstances were judged to be too risky for a needle biopsy. Therefore, it was decided to biopsy another nodule in the left lung that was visible on the same CT section. During this portion of the procedure, the patient became hypoxic and developed pulseless electrical activity arrest. Cardiopulmonary resuscitation was unsuccessful and the efforts ceased after 45 min. Subsequent review of CT scan revealed air in the left ventricle.


  • Contributors FK contributed towards conceptualisation and drafting the article. SR provided description for the images and assisted in draft revision. RAR provided insight regarding the integrity of the paper. SG provided final revision of the draft and its intellectual content.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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