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PURPOSE To quantitatively analyze the risk factors for air embolism following computed tomography -guided percutaneous transthoracic needle biopsy (CT-guided PTNB) and qualitatively review their characteristics. METHODS PubMed, Embase, Web of Science, Wanfang Data, VIP information, and China National Knowledge Infrastructure were searched on January 4, 2021, for studies reporting the occurrence of air embolisms following CT-guided PTNB. After study selection, data extraction, and quality assessment, the characteristics of the included cases were qualitatively and quantitatively analyzed. RESULTS A total of 155 cases of air embolism following CT-guided PTNB were reported. The reported incidence was 0.06% to 4.80% and 35 (22.58%) patients were asymptomatic. An unconscious or unresponsive state were the most common symptoms (29.68%). Air was most commonly found in the left ventricle (45.16%). 84(62.22%) patients recovered without sequelae. Air location (P = .003), emphysema (P = .061), and cough (P = .076) were associated with clinical symptoms. Air location (P = .015) and symptoms (P < .001) were significantly associated with prognosis. Lesion location (OR = 1.85, P = .017), lesion subtype (OR = 3.78, P = .01), pneumothorax (OR = 2.16, P = .003), hemorrhage (OR = 3.20, P < .001), and lesions located above the left atrium (OR = 4.35, P = .042) were significant risk factors for air embolism. CONCLUSION Based on current evidence, subsolid lesion, located in lower lobe, pneumothorax, hemorrhage, and lesions located above the left atrium were significant risk factors for air embolism.