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Reminder of important clinical lesson
Atrial fibrillation and pneumothorax after transthoracic needle lung biopsy
  1. Alexander Liu1,
  2. Iain Southern2,
  3. Edward Nicol3
  1. 1Acute Admissions Unit, Chelsea and Westminster Hospital, London, UK
  2. 2Respiratory Department, Chelsea and Westminster Hospital, London, UK
  3. 3Cardiology Department, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Alexander Liu, alexander.liu104{at}


An obese 65-year-old male smoker with chronic obstructive pulmonary disease developed an iatrogenic pneumothorax with pulmonary haemorrhage during an elective transthoracic needle biopsy of a pulmonary lesion. Successful re-inflation was achieved with a chest drain which was then removed before transfer to the medical ward. He later developed persistent atrial fibrillation with breathlessness and haemoptysis. He was treated empirically for a pulmonary embolus, which was subsequently ruled out with CT pulmonary angiogram. Serial chest radiographs demonstrated recurrence of his pneumothorax and a chest drain was re-inserted. His atrial fibrillation was erroneously managed as supraventricular tachycardia, which was resistant to vagal manoeuvres and adenosine but later responded to intravenous amiodarone before a further relapse. Upon successful management of the pneumothorax, his atrial fibrillation terminated. This case highlighted the persistent and serious nature of complications posttransthoracic needle biopsy.

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  • Competing interests None.

  • Patient consent Obtained.

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