European Radiology

, Volume 18, Issue 7, pp 1356–1363

Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy

  • M. F. Khan
  • R. Straub
  • S. R. Moghaddam
  • A. Maataoui
  • J. Gurung
  • T. O. F. Wagner
  • H. Ackermann
  • A. Thalhammer
  • T. J. Vogl
  • V. Jacobi
Chest

Abstract

The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectivly. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occured in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occured in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occured when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax.

Keywords

CT-guided biospy Lung Complication Pneumothorax Hemorrhage 

Abbreviations

MDCT

Multidetector Computed Tomography

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • M. F. Khan
    • 1
  • R. Straub
    • 1
  • S. R. Moghaddam
    • 1
  • A. Maataoui
    • 1
  • J. Gurung
    • 1
  • T. O. F. Wagner
    • 2
  • H. Ackermann
    • 3
  • A. Thalhammer
    • 1
  • T. J. Vogl
    • 1
  • V. Jacobi
    • 1
  1. 1.Institute for Diagnostic and Interventional RadiologyJohann Wolfgang Goethe University, FrankfurtFrankfurt am MainGermany
  2. 2.Medical Clinic II, Department of Pneumology and AllergologyJohann Wolfgang Goethe University, FrankfurtFrankfurt am MainGermany
  3. 3.Institute for Epidemilogy and Medical StatisticsJohann Wolfgang Goethe University, FrankfurtFrankfurt am MainGermany

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