Percutaneous transthoracic needle aspiration: a review. Delayed pneumothorax after central venous access: a potential hazard. Only a few studies have given attention to the developing time of pneumothorax [17–19]. In the present study, pneumothorax developed in 30% of CTLB procedures, comparable to previous studies [9, 20]. After puncturing the skin, the patients were instructed to hold their breath at a normal expiration and the pleural puncture was subsequently made. and 157 ultrasonography-guided lung biopsies were performed. Data curation, First, the study was based on single institution and population of non-immediate cases were relatively small. No, Is the Subject Area "Biopsy" applicable to this article? Delayed pneumothorax has been also reported as a complication of transbronchial lung biopsy, 14 and of subclavian vein catheterization. View Article PubMed/NCBI Google Scholar 25. Third, immediate and delayed pneumothorax was detected in CT and chest radiographs, respectively. CTLB was performed in the inpatient setting. https://doi.org/10.1371/journal.pone.0238107.s001. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. The requirements for written informed consent were waived owing to the retrospective nature of the study. Adult patients underwent TTNB from June 2001 to June 2002. Pneumothorax developed in 100 of the 458 patients (21.8%), and delayed pneumothorax developed in 15 patients (3.3%). The chest X-ray is repeated after three hours to exclude a delayed pneumothorax. They include 135 cases (83.9%) of immediate pneumothorax and 26 cases (16.1%) of delayed pneumothorax. Yes Differences were considered significant at p < 0.05. and the necessity for pigtail catheterization or chest tube insertion in these patients. © 2004 The American College of Chest Physicians. Occasional delayed pneumothoraces have been reported more than 24 hours after biopsy, despite the absence of a pneumothorax on chest radiographs taken 4 hours after biopsy. Yes A follow-up chest radiograph However, the diagnostic yield of this practice has not been studied broadly. The incidence of delayed pneumothorax was 3.3% of all TTNBs. Pneumothorax developed in 161 patients (30.0%). One hundred and thirty-nine participants were referred for CT-guided percutaneous lung biopsy, and 81 were … The exact mechanism behind this delayed occurrence is yet to be determined. Brown KT, Brody LA, Getrajdman GI, et al. Full Text. 15. catheter or chest tube. of delayed pneumothorax (p < 0.05). Therefore, lesion location as a risk factor for delayed pneumothorax may differ from that in previous studies in which all cases of pneumothorax were included regardless of the onset time. If the patient develops pneumothorax during a transthoracic needle biopsy (TNB), they will be observed for several hours. Although biopsy related pneumothorax frequently occurs during or immediately after procedure, pneumothorax can be identified in the follow-up chest radiographs or even after discharge due to chest pain or dyspnea (delayed pneumothorax) [13, 14]. 2003. Investigation, The rates of chest tube insertion between immediate and delayed pneumothorax were compared. In multivariate analysis, lesion size (odds ratio [OR] = 0.779; 95% confidence interval [CI] = 0.690–0.878), middle/lower lobe location (OR = 2.344; CI = 1.524–3.610), long intrapulmonary biopsy track (OR = 1.25; CI = 1.139–1.541), increased number of pleural punctures (OR = 1.604; CI = 1.153–2.235), and presence of emphysema in affected lobe (OR = 2.042; CI = 1.255–3.322) were risk factors for pneumothorax (Table 3). Project administration, Significance of lesion location on delayed pneumothorax has not been demonstrated due to sparsity of related studies. assessing risk factors for delayed pneumothorax failed to demonstrate the significance of lesion location as a contributing factor [17]. If the procedure has been performed on an outpatient basis, the patient can be discharged home on the same day. here. Multi-detector computed tomography; GGO, Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. Since CTLBs were performed in inpatient setting at our institution, the precise rate of delayed pneumothorax could be obtained. Radiology 1997; 205:249-252. found a significantly higher risk of immediate pneumothorax in patients with emphysema [17]. PLOS ONE promises fair, rigorous peer review, In the present study, delayed pneumothorax showed higher requirement of chest tube drainage, than immediate pneumothorax (19.2% vs. 6.7%). Delayed pneumothorax group had smaller lesion (p < 0.001), upper lobe location (p = 0.02), and increased number of pleural punctures (p < 0.001), compared to the group without pneumothorax (Table 1). The pneumothorax complicating bronchoscopic transbronchial lung biopsy in our patient was identified at the time of the procedure and was clearly iatrogenic. Delayed pneumothorax was defined as pneumothorax developed after the biopsy needle is removed. No, Is the Subject Area "Medical risk factors" applicable to this article? To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to … Therefore, each pneumothorax group was compared with the non-pneumothorax group. Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea, Aspiration needle biopsy of thoracic lesions. Writing – original draft, The procedure however comes with inherent risks, the most common being bleeding and pneumothorax. Project administration, Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. Pneumothorax was considered to be “delayed” when it was first detected in follow-up chest radiographs after biopsy. DISCUSSION. The initial follow-up chest radiograph taken at 4 h after procedure revealed persistence of immediate pneumothorax in 55 of 135 cases (40.7%). Yes analyze the influence of multiple variables on the rate of delayed pneumothorax associated reported that the left upper lobe location was an independent risk factor for pneumothorax, in contrast to other studies, with delayed pneumothorax contributing to about one-third (66/253, 29.6%) of total pneumothorax in their study group [21]. There was delayed pneumothorax, such as a case in 5 days after operation. The risk of pneumothorax increases with increasing number of pleural punctures [29–31]. Other proposed mechanisms and associated risk factors that are known to contribute to the development of delayed pneumothorax include absence of emphysematous changes in the lung parenchyma, persistence of a tissue flap after biopsy (obstructing the air flow), and microbial seeding through the puncture site. We use cookies to help provide and enhance our service and tailor content and ads. Among variables contributing to the risk of pneumothorax, factors other than small lesion size remain controversial [9, 19, 21–24]. Patient’s age and gender, lesion size, lesion location (upper lobe vs. middle/lower lobe), lesion type (solid nodule/mass vs. consolidation/GGO), pathologic results (benign vs. malignancy), number of pleural punctures, pleural puncture angle (vertical vs. oblique), length of intrapulmonary biopsy track, needle indwelling time, and the presence or absence of emphysema in the affected lobe were compared among different groups (no pneumothorax, total pneumothorax, immediate pneumothorax, and delayed pneumothorax). After completion of tissue sampling, all patients underwent immediate CT scanning on the table to detect procedure-related complications. The rate of chest tube insertion was significantly higher in delayed group (19.2%) than in immediate group (6.7%) (P < 0.001). Procedures were performed under the guidance of 16-slice MDCT scanner (LightSpeed 16, GE Healthcare). After removing the biopsy needle, post-procedure check CT was obtained with the patient in a supine position to detect any complications. About 5% to 22.8% of CT-guided biopsy-induced pneumothorax cases require chest tube insertion, which increase the need for hospitalization, cost and discomfort. Data curation, Our study has several limitations. Ground-glass opacity; OR, However, depending on patients’ condition, the examination time was modified or additional chest radiographs were obtained. Fourth, immediate and non-immediate pneumothorax was considered mutually exclusive but both events possibly occurred in a same patient. Boskovic T, Stojanovic M, Stanic J, et al. Conclusion: Obtaining a routine follow-up CXR in all patients after CT-guided lung biopsy appears warranted, given the high rate of delayed pneumothorax and large percentage of patients who will require a chest tube. Fourteen of 161 cases (8.7%) of pneumothorax required chest tube or drainage catheter placement. Citation: Bae K, Ha JY, Jeon KN (2020) Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence. Data curation, By continuing you agree to the, Incidence and Risk Factors of Delayed Pneumothorax After Transthoracic Needle Biopsy of the Lung, picture archiving and communication system. Conceptualization, Incidence of delayed pneumothorax, defined as PTX post 4 hour of TBB, is reportedly 5% in the general population . Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Noh et al. However, since immediate and delayed pneumothorax were detected using different modalities, chest tube insertion rates between the two groups should not be directly compared. Outpatient Treatment of Iatrogenic Pneumothorax after Needle Biopsy. Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure and pneumothorax is the most frequently associated adverse event. Traill et al. A timely diagnosis of pneumothorax is clinically important for management of patients. After biopsy, all patients were placed in the decubitus position to compress the biopsy site. Patients should be warned of the possible occurrence of this complication and instructed to seek medical help if they develop chest pain or breathlessness. gender and the absence of an emphysematous change correlated with an increased rate broad scope, and wide readership – a perfect fit for your research every time. The demand for lung biopsy is growing due to an increase in detection of lung tumor in screening and the need for molecular and genomic profiling of non-small cell lung cancer [1–3]. Yes The most prevalent complication of percutaneous lung biopsy is pneumothorax (PNX). However, 10 of 15 cases of delayed pneumothorax occurred in upper lobes, while lesion distribution in the total population showed almost equal distributions (upper vs. middle/ lower = 242 vs. 216). Complications of CT guided lung biopsy have been well documented and include pneumothorax (4-60%), pneumothorax requiring chest drain (5-10%), haemoptysis (10%), pain, air embolism, atrial fibrillation, tumour seeding of the biopsy tract and, on rare occasions, death (0.5%)[1–13]. 2004;126:1516–21. Methodology, Effective monitoring of patients after procedure requires detection of patients who are at risk of delayed development of pneumothorax. However, this is common practice pattern in CTLB since it is not practical to obtain chest radiographs immediately after biopsy CT [20, 34]. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. The position of the needle tip was confirmed by obtaining limited CT images of 3–5 mm thickness around the lesion. DOI: https://doi.org/10.1378/chest.126.5.1516. A pneumothorax that developed after 3 hours was defined as delayed pneumothorax. Accepted: Manual aspiration in biopsy-side down position demonstrates the safety and efficacy in treating delayed pneumothorax after CT-guided TTNBs. Occurrence of pneumothorax (PTX) post transbronchial lung biopsy is very low approximately 1–2% . 1 Introduction. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung From CHEST, 11/1/04 by Chang-Min Choi. Pneumothorax after transbronchial needle biopsy. We report a lung transplant patient who developed a pneumothorax 5 months after transbronchialbiopsy.Multipleinterveningchestcomputed tomograms (CTs) document that the pneumothorax devel- oped from the biopsy site. No, Is the Subject Area "Cancer risk factors" applicable to this article? Written informed consent was obtained from all patients before undergoing procedures. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. The intrapulmonary needle track was significantly longer in the upper lobes than in the middle/lower lobes (1.81 ± 1.56 cm vs. 1.27 ± 1.25 cm, p < 0.001) in delayed group. CTLB, Among them, 9 cases were in immediate group and 5 cases were in delayed group. Patients were asked to lie with the puncture site down and coughing and ambulation was discouraged for the first 4 h. Inspiration upright posteroanterior chest radiograph was routinely performed at 4 h after procedure and prior to discharge. Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. 14. that had not developed up to 3 h but developed later was defined as a delayed pneumothorax. Statistical analyses were performed using commercial software (SPSS, version 24.0, SPSS Inc.). We did not routinely acquire chest radiographs earlier than 4 h after procedure. For more information about PLOS Subject Areas, click There were 372 males and 164 females with a mean age of 65.8 (range, 18–90) years. Of all cases of pneumothorax, 16.1% was delayed occurrence. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Seventeen patients, including 3 patients with delayed November 4, '2 Pneumothorax has been reported to occur after about 5%oftransbronchial lung biopsies and is the most commoncomplication oftheprocedure.3-Manyextensive reviews of fibreoptic bronchoscopy with transbronchial biopsy, however, make no mention of the occurrence of delayed pneumothorax after the procedure. Thorax 1997; 52:581-582. Is the Subject Area "Pneumothorax" applicable to this article? The disruption of dilated air spaces and the lack of elastic recoil in emphysematous lung may prevent rapid sealing of the air leak, resulting in early manifestations of pneumothorax [32, 33]. here. 3–5 While delayed pneumothorax has been previously reported, our report is unique due to the magnitude of elapsed time between the transbronchial biopsy and the development of the pneumothorax, and the clear evolution … Such delayed pneumothorax after lung biopsy is extremely unusual. Immediate pneumothorax was associated with smaller lesions (p < 0.001), middle/lower lobe location (p < 0.001), longer intrapulmonary needle track (p = 0.01), and emphysema (p = 0.007), compared to the group without pneumothorax. devices, and underlying diseases were not correlated with the delayed pneumothorax Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage. Yes Among the 458 patients included in this study, 280 fluoroscopic-guided, 21 CT-guided, Crossref, Medline, Google Scholar; 18 Moore EH, LeBlanc J, Montesi SA, Richardson ML, Shepard JA, McLoud TC. Writing – review & editing, Roles Lesion size, location, biopsy guidance methods, devices, and underlying diseases were not correlated with the delayed pneumothorax rate. Seventeen patients, including 3 patients with delayed pneumo- '-' Wereport Such delayed pneumothorax after lung biopsy is extremely unusual. Data Availability: All relevant data are within the paper and its Supporting Information file. All biopsies were performed as inpatient procedures. low. Patients’ demographics, lesion characteristics, and procedure-related variables are summarized in Table 1. https://doi.org/10.1371/journal.pone.0238107.t001. Pleural injury involving lower lobes with higher aeration and ventilatory movement may lead to early appearance of pneumothorax. An overall flow diagram of the methodology undertaken in the study is presented in Fig 1. https://doi.org/10.1371/journal.pone.0238107.g001. The purpose of this study was to determine the risk factors and clinical significance of delayed pneumothorax after CTLB, compared to those of immediate pneumothorax. More than half of immediate pneumothorax was resolved quickly. However, lobar location of the lesion was the most powerful variable in each group. 15, 16 Our prospective study shows that the delayed pneumothorax rate was 3.3% (15 of 496 procedures) in … Yes Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717–0.922 and OR = 0.610; CI = 0.441–0.844, respectively). To evaluate the rate of iatrogenic pneumothorax and the need for intervention with extrapleural autologous blood injection (EPABI) along with intraparenchymal autologous blood patch injection (IABPI) or IABPI-only in CT-guided percutaneous lung biopsy. Huang Y, Huang H, Li Q, et al. reported similar results in which only 38% of CT detected pneumothorax showed persistence in follow-up chest radiographs at 4 h after biopsy and 21% of them required chest tube drainage [20]. With small size of pneumothorax and inconspicuous dyspnea, the patients may be taken oxygen therapy and close observation. 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