Man With Acute Unconsciousness

A 68-year-old man presented for elective computed tomography (CT)-guided localization of a pulmonary nodule before planned thoracoscopic segmentectomy. Preoperative imaging had identified a 1-cm mixed ground-glass nodule in the superior segment of the right lower lobe (Fig 1). Approximately 1 minute after removal of the localization needle, the patient abruptly developed dizziness and nausea, followed by rapid loss of consciousness. Initial assessment revealed hypotension, hypoxemia, and sluggish bilateral pupillary light reflexes.