CardioVascular and Interventional Radiology

, Volume 31, Issue 2, pp 342–348 | Cite as

Outpatient Management of Postbiopsy Pneumothorax with Small-Caliber Chest Tubes: Factors Affecting the Need for Prolonged Drainage and Additional Interventions

  • Sanjay Gupta
  • Marshall E. Hicks
  • Michael J. Wallace
  • Kamran Ahrar
  • David C. Madoff
  • Ravi Murthy
Clinical Investigation


The aim of this study was to evaluate the efficacy of outpatient management of postbiopsy pneumothoraces with small-caliber chest tubes and to assess the factors that influence the need for prolonged drainage or additional interventions.

We evaluated the medical records of patients who were treated with small-caliber chest tubes attached to Heimlich valves for pneumothoraces resulting from image-guided transthoracic needle biopsy to determine the hospital admission rates, the number of days the catheters were left in place, and the need for further interventions. We also evaluated the patient, lesion, and biopsy technique characteristics to determine their influence on the need for prolonged catheter drainage or additional interventions. Of the 191 patients included in our study, 178 (93.2%) were treated as outpatients. Ten patients (5.2%) were admitted for chest tube-related problems, either for underwater suction (n = 8) or for pain control (n = 2). No further interventions were required in 146 patients (76.4%), with successful removal of the chest tubes the day after the biopsy procedure. Prolonged catheter drainage (mean, 4.3 days) was required in 44 patients (23%). Nineteen patients (9.9%) underwent additional interventions for management of pneumothorax. Presence of emphysema was noted more frequently in patients who required additional interventions or prolonged chest tube drainage than in those who did not (51.1% vs. 24.7%; = 0.001).

We conclude that use of the Heimlich valve allows safe and successful outpatient treatment of most patients requiring chest tube placement for postbiopsy pneumothorax. Additional interventions or prolonged chest tube drainage are needed more frequently in patients with emphysema in the needle path.


Lung Biopsy Complications Pneumothorax 


  1. 1.
    Anderson JM, Murchison J, Patel D (2003) CT-guided lung biopsy: factors influencing diagnostic yield and complication rate. Clin Radiol 58:791–797PubMedCrossRefGoogle Scholar
  2. 2.
    Cox JE, Chiles C, McManus CM et al. (1999) Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 212:165–168PubMedGoogle Scholar
  3. 3.
    Geraghty PR, Kee ST, McFarlane G et al. (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229:475–481PubMedCrossRefGoogle Scholar
  4. 4.
    Gupta S, Krishnamurthy S, Broemeling LD et al. (2005) Small (<=2-cm) subpleural pulmonary lesions: short- versus long-needle-path Ct-guided biopsy–comparison of diagnostic yields and complications. Radiology 234:631–637PubMedCrossRefGoogle Scholar
  5. 5.
    Kazerooni EA, Lim FT, Mikhail A et al. (1996) Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 198:371–375PubMedGoogle Scholar
  6. 6.
    Saji H, Nakamura H, Tsuchida T et al. (2002) The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 121:1521–1526PubMedCrossRefGoogle Scholar
  7. 7.
    Westcott JL, Rao N, Colley DP (1997) Transthoracic needle biopsy of small pulmonary nodules. Radiology 202:97–103PubMedGoogle Scholar
  8. 8.
    Yeow KM, Su IH, Pan KT et al. (2004) Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 126:748–754PubMedCrossRefGoogle Scholar
  9. 9.
    Brown KT, Brody LA, Getrajdman GI et al. (1997) Outpatient treatment of iatrogenic pneumothorax after needle biopsy. Radiology 205:249–252PubMedGoogle Scholar
  10. 10.
    Dennie CJ, Matzinger FR, Marriner JR et al. (2001) Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. Radiology 219:247–251PubMedGoogle Scholar
  11. 11.
    Perlmutt LM, Braun SD, Newman GE et al. (1987) Transthoracic needle aspiration: use of a small chest tube to treat pneumothorax. AJR 148:849–851PubMedGoogle Scholar
  12. 12.
    Swischuk JL, Castaneda F, Patel JC et al. (1998) Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. J Vasc Interv Radiol 9:347–352PubMedCrossRefGoogle Scholar
  13. 13.
    Cannon WB, Mark JB, Jamplis RW (1981) Pneumothorax: a therapeutic update. Am J Surg 142:26–29PubMedCrossRefGoogle Scholar
  14. 14.
    McKenna RJ Jr, Fischel RJ, Brenner M et al. (1996) Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. Ann Thorac Surg 61:1115–1117PubMedCrossRefGoogle Scholar
  15. 15.
    Mercier C, Page A, Verdant A et al. (1976) Outpatient management of intercostal tube drainage in spontaneous pneumothorax. Ann Thorac Surg 22:163–165PubMedCrossRefGoogle Scholar
  16. 16.
    Laronga C, Meric F, Truong MT et al. (2000) A treatment algorithm for pneumothoraces complicating central venous catheter insertion. Am J Surg 180:523–526, discussion 526–527PubMedCrossRefGoogle Scholar
  17. 17.
    Ponn RB, Silverman HJ, Federico JA (1997) Outpatient chest tube management. Ann Thorac Surg 64:1437–1440PubMedCrossRefGoogle Scholar
  18. 18.
    Cerfolio RJ, Bass CS, Pask AH et al. (2002) Predictors and treatment of persistent air leaks. Ann Thorac Surg 73:1727–1730, discussion 1730–1721PubMedCrossRefGoogle Scholar
  19. 19.
    Covey AM, Gandhi R, Brody LA et al. (2004) Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 15:479–483PubMedGoogle Scholar
  20. 20.
    Ko JP, Shepard JO, Drucker EA et al. (2001) Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors? Radiology 218:491–496PubMedGoogle Scholar
  21. 21.
    Gurley MB, Richli WR, Waugh KA (1998) Outpatient management of pneumothorax after fine-needle aspiration: economic advantages for the hospital and patient. Radiology 209:717–722PubMedGoogle Scholar
  22. 22.
    Cerfolio RJ, Bass C, Katholi CR (2001) Prospective randomized trial compares suction versus water seal for air leaks. Ann Thorac Surg 71:1613–1617PubMedCrossRefGoogle Scholar
  23. 23.
    Marshall MB, Deeb ME, Bleier JI et al. (2002) Suction vs water seal after pulmonary resection: a randomized prospective study. Chest 121:831–835PubMedCrossRefGoogle Scholar
  24. 24.
    Rice TW, Okereke IC, Blackstone EH (2002) Persistent air-leak following pulmonary resection. Chest Surg Clin N Am 12:529–539PubMedCrossRefGoogle Scholar
  25. 25.
    Brown TS, Kanthapillai P (1998) Transthoracic needle biopsy for suspected thoracic malignancy in elderly patients using CT guidance. Clin Radiol 53:116–119PubMedCrossRefGoogle Scholar
  26. 26.
    Cerfolio RJ, Tummala RP, Holman WL et al. (1998) A prospective algorithm for the management of air leaks after pulmonary resection. Ann Thorac Surg 66:1726–1731PubMedCrossRefGoogle Scholar
  27. 27.
    Yankelevitz DF, Davis SD, Henschke CI (1996) Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology 200:695–697PubMedGoogle Scholar
  28. 28.
    Yamagami T, Nakamura T, Iida S et al. (2002) Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest 121:1159–1164PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sanjay Gupta
    • 1
    • 2
  • Marshall E. Hicks
    • 1
  • Michael J. Wallace
    • 1
  • Kamran Ahrar
    • 1
  • David C. Madoff
    • 1
  • Ravi Murthy
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Division of Diagnostic ImagingThe University of Texas M. D. Anderson Cancer CenterHoustonUSA

Personalised recommendations