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

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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.

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Abbreviations

MDCT:

Multidetector Computed Tomography

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    M. F. Khan, R. Straub, S. R. Moghaddam, A. Maataoui, J. Gurung, A. Thalhammer, T. J. Vogl & V. Jacobi

  2. Medical Clinic II, Department of Pneumology and Allergology, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    T. O. F. Wagner

  3. Institute for Epidemilogy and Medical Statistics, Johann Wolfgang Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    H. Ackermann

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  1. M. F. Khan
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  2. R. Straub
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  3. S. R. Moghaddam
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  4. A. Maataoui
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Correspondence to M. F. Khan.

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Khan, M.F., Straub, R., Moghaddam, S.R. et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 18, 1356–1363 (2008). https://doi.org/10.1007/s00330-008-0893-1

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  • DOI: https://doi.org/10.1007/s00330-008-0893-1

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