Rationale: Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions.
Patient concerns: A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization.
Diagnosis: Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery.
Interventions: The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment.
Outcomes: Clinical death occurred 55 hours after air embolism.
Lessons: Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.