Is CT-guided lung biopsy in high risk-emphysematic patients a contraindication? E. Sotiropoulou , P. Filippousis , S. Apostolopoulou , V. Tsagouli , F. Laspas, A. Bouga , I. Tsagaridou , L. Thanos . Department of Medical Imaging and Interventional Radiology, "Sotiria" General Hospital of Chest Diseases Athens, Greece. INTRODUCTION Transthoracic needle biopsy with imaging guidance is an established method to diagnose a variety of thoracic abnormalities. Y-C Chang et al J Thorac Imaging 2003; 18:21-26 AIM To analyze the influence of multiple variables on the rate of pneumothorax and chest tube placement associated with transthoracic needle aspiration biopsy of the lung in patients with emphysema. MATERIAL AND METHODS In 900 patients, computed tomographically (CT) guided lung biopsies were performed. 90 patients (10%) were emphysematic. Variables analyzed were lesion size, depth and location; number of pleural passes; needle size (we used automatic cutting needle 18G); presence of emphysema; and training level of the person who performed the biopsy. RESULTS ► Pneumothorax occurred in 20 (22.2%) of 90 emphysematic patients. Double valve chest tube placement was needed in 8 of 20 cases of pneumothorax (40%). ► An increased rate of pneumothorax was correlated with smaller lesion size. ► Needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate. ► Also for peripheral lesions the rate of pneumothorax was lower [12 of 90 patients had peripheral lesion and none (0%) of them did pneumothorax]. ► In 5 patients hemoptysis was observed. COMPLICATIONS (1) ► Pneumothorax was the most common complication. ► Occurred in 20 of 90 emphysematic patients (22,2%) ► In 8 of 20 cases of pneumothorax (40%) required thoracic drainage [8 of 90 biopsied patients (8,9%)]. The most common complication of fine needle aspiration is pneumothorax with incidence that ranges from 0% to 61%, 20% in most large series, and the percentage of biopsy patients requiring treatment of pneumothaorax with chest tube averages approximately 7%. Klein et al Radiol Clin North Am 2000; 38:235-266 In our study pneumothorax rate: Was correlated with: ► Emphysema ► Smaller lesion size ► Increased depth size Was not correlated with: ► Needle size ► Number of pleural passes ► Level of training In most series, factors that have been associated with a higher risk of pneumothorax include : ► increased outer diameter of biopsy needle ► increased depth and decreased size of the lesion ► increased number of times that the thoracic pleura is traversed ► the presence of obstructive airways disease or emphysema Laurent et al Eur J Radiol 2002; 45:60-68 COMPLICATIONS (2) ► Hemorrhage around the lesion or along the needle track was observed on the post- biopsy CT slices was the second most common complication. ► In 5 patients hemoptysis was observed. Hemorrhage, with or without hemoptysis, is the second most common and the most dangerous potential complication of percutaneous lung biopsy. The reported incidence of hemorrhage ranges from 0% to 10%, with most series reporting an incidence of less than 5%. Klein et al Radiol Clin North Am 2000; 38:235-266 CONCLUSION Emphysema is strongly correlated with occurrence of pneumothorax. Chest tube placement was related to the presence of emphysema. However the degree of collapse is small and resolves on its own without treatment. FNA in emphysematic patients isn’t forbidden for the diagnosis of lung disease.
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