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Vascular and Interventional Radiology |
1 From the Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC. Received June 17, 1998; revision requested July 30; revision received September 22; accepted December 16. Address reprint requests to J.E.C., 59 MDW/MTRD, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236-5300 (e-mail: joecox@aol.com).
PURPOSE: 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.
MATERIALS AND METHODS: In 346 patients, 331 computed tomographically (CT) guided and 24 fluoroscopically guided lung biopsies were performed. Variables analyzed were lesion size, depth, and location; number of pleural passes; needle size; presence of emphysema; and training level of the person who performed the biopsy.
RESULTS: Pneumothorax occurred at 144 (40.4%) of 356 biopsies, including 139 (42.0%) CT-guided and five (21%) fluoroscopically guided biopsies. Chest tube placement was needed in 25 (17.4%) of 144 cases of pneumothorax (7% of all biopsies). An increased rate of pneumothorax was correlated with smaller lesion size (P = .001) and presence of emphysema (P = .01). Patients with emphysema were three times as likely to require chest tube placement. The pneumothorax rate was 15% (16 of 105) if no aerated lung was traversed and approximately 50% if aerated lung was penetrated. Lesion location, needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate.
CONCLUSION: Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.
Index terms: Biopsies, complications, 60.411, 60.732 • Computed tomography (CT), guidance, 60.12111 • Lung, biopsy, 60.126, 60.732 • Pneumothorax, 60.411, 60.732
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