Incidence and influencing factors of vasovagal reaction in computed tomography (CT)-guided localisation of pulmonary ground-glass nodules prior to video-assisted thoracoscopic surgery

• Published in: Clinical radiology Vol. 85; p. 106910
• Main Authors: Feng, H.X., Huang, Z.G., Sun, H.L., Xu, Y.Y., Wang, Y.L., Gao, B.X., Li, C.D., Zhang, T.Y., Li, H.Y., Hu, Y.W.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2025
• Subjects: Adult; Aged; Female; Humans; Incidence; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - surgery; Male; Middle Aged; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - surgery; Radiography, Interventional - adverse effects; Radiology; Retrospective Studies; Risk Factors; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - surgery; Syncope, Vasovagal - epidemiology; Syncope, Vasovagal - etiology; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - methods
• ISSN: 0009-9260; 1365-229X; 1365-229X
• DOI: 10.1016/j.crad.2025.106910

To investigate the incidence, clinical features, and influencing factors of vasovagal reaction (VVR) associated with computed tomography (CT)-guided localisation of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS). A total of 1303 consecutive patients who underwent CT-guided localisation of GGNs were selected as research subjects. VVR related to CT-guided localisation was defined as the onset of otherwise unexplained transient hypotension and/or relative bradycardia during or after localisation, manifesting as symptoms such as pallor, sweating, nausea, and potentially syncope. Risk factors for VVR were identified through both univariate and multivariate analyses. VVR was observed in 4.5% (58/1,303) of the patients. All VVRs occurred postlocalisation, with 91.4% (53/58) happening between the time patients rose from the CT table and their departure from the CT room. Prodromal symptoms were evident in all VVR cases, with two cases progressing to syncope, each with a brief loss of consciousness lasting less than one minute. Univariate analysis identified significant risk factors for VVR, including patient age, stress level, history of syncope, and the marking of multiple GGNs, as well as marking time. Multivariate logistic regression analysis revealed that patient stress (odds ratio [OR], 20.17; P < 0.001) and a history of syncope (OR, 8.06; P = 0.002) were independent risk factors for VVR. VVR affects approximately 4.5% of patients undergoing CT-guided localisation of GGNs, often manifesting immediately after rising from the CT table. Patient stress and a history of syncope are significantly associated with an increased likelihood of VVR. •VVR occurs in about 4.5% of patients undergoing CT-guided localisation of GGNs.•VVR mostly occurs before leaving the CT room after localisation.•Once a patient occurs prodromal symptoms, the possibility of VVR should be considered.•Patient stress and history of syncope are correlated with higher occurrence of VVR.