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Published 8 May 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.01.2009.1496]
Copyright © 2009 by the BMJ Publishing Group Ltd.

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Pneumothorax: a common complication of CT-guided transthoracic needle lung biopsy

Subhash Chandra1, Dipti Agarwal2, Vikash Singh3, Anant Mohan1, Randeep Guleria3

1 AIIMS, Medicine, Ansari Nagar, New Delhi, Delhi, 110029, India
2 Kailash Clinic, Medicine, Ashok Vihar, New Delhi, 110052, India
3 All India Institue of Medical Sceinces, Medicine, Ansari Nagar, New Delhi, Delhi, 110029, India

Correspondence to:
Subhash Chandra, subhash_doc84{at}yahoo.com

A 60-year-old intubated male underwent CT-guided transthoracic needle lung biopsy (TNLB) for right upper lobe mass, which proved to be small cell lung cancer. Soon after the procedure, O2 saturation decreased drastically and chest radiogram (CXR) showed appearance of pneumothorax, which was resolved completely on chest tube insertion (figs 1 and 2).


Figure 1
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Figure 1 Serial chest radiogram showing development of pneumothorax following CT-guided transthoracic needle lung biopsy in an intubated patient.

 


Figure 2
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Figure 2 Serial chest radiograms showing resolution of pneumothorax following chest tube insertion.

 

Pneumothorax is a known complication of CT-guided TNLB with prevalence of 8–64%.1 Risk of pneumothorax is higher with lesion size <2 cm, subpleural lesion depth of 0.1–2.0 cm, the angle of the needle, a less experienced radiologist and a greater movement of the lung while the needle is in the lung.1,2 Whereas age, pulmonary function test, emphysema, cavitation of the lesion, needle size, number of specimens and post-biopsy patient positioning show no association with an increased risk of pneumothorax.1,2

Smaller coaxial stabilising needle decreases risk of pneumothorax with comparable diagnostic accuracy, sensitivity and specificity.1 Keeping the needle as vertical as possible to the pleura also decreases chances of pneumothorax. Immediate percutaneous aspiration even for an asymptomatic and not large pneumothorax decreases progression of pneumothorax and need of chest tube.3


LEARNING POINTS

  • Risk of pneumothorax is higher with lesion size <2 cm, subpleural lesion depth of 0.1–2.0 cm, the angle of the needle, a less experienced radiologist and greater movement of the lung while the needle is in the lung.
  • Smaller coaxial stabilising needle decreases risk of pneumothorax with comparable diagnostic accuracy, sensitivity and specificity.


Competing interests: none.

Patient consent: Patient/guardian consent was obtained for publication.

REFERENCES

  1. Geraghty, PR, Kee, ST, McFarlane, G, et al. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003; 229: 475–81.[Abstract/Free Full Text]
  2. Gohari, A, & Haramati, LB. Complications of CT scan-guided lung biopsy: lesion size and depth matter. Chest 2004 Sep; 126: 666–8.[CrossRef][Medline]
  3. Yamagami, T, Nakamura, T, Lida, S, et al. Management of Pneumothorax After Percutaneous CT-Guided Lung Biopsy. Chest 2002; 121: 1159–64.[CrossRef][Medline]

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