Complications of CT-Guided Percutaneous Needle Biopsy of the Chest: Prevention and Management

Abstract

Pneumothorax and pulmonary hemorrhage are the most common complications of percutaneous needle biopsy of the chest, whereas air embolism and tumor seeding are extremely rare. Attention to biopsy planning and technique and postprocedural care help to prevent or minimize most potential complications.

CT-guided transthoracic biopsy: histopathologic results and complication rates

“…The second most common complication observed in percutaneous transthoracic biopsy is parenchymal hemorrhage with an incidence of 5%-10% (11,14,16). In our study, eight patients (8.5%) developed parenchymal hemorrhage, which is consistent with the literature.…”

“…However, 10 (37%) patients who had pneumothorax in more than 20% of lung volume were treated by inserting a pigtail catheter. In cases where pneumothorax develops during the procedure, manual aspiration can be done by inserting a different needle through a needle guide or into the pleural space (14). Also, development of pneumothorax can be avoided by the "patching technique", where the air leakage is reduced by closing the biopsy tract with 2-3 mL injections of patient's own blood or fibrin tissue sealant when withdrawing the needle (12,14).…”

“…In cases where pneumothorax develops during the procedure, manual aspiration can be done by inserting a different needle through a needle guide or into the pleural space (14). Also, development of pneumothorax can be avoided by the "patching technique", where the air leakage is reduced by closing the biopsy tract with 2-3 mL injections of patient's own blood or fibrin tissue sealant when withdrawing the needle (12,14). The biopsy tract can also be sealed by dripping 3-4 mL of 0.9% NaCl solution when withdrawing the needle guide (15).…”

Interstitial Fluid Pressure Correlates Clinicopathological Factors of Lung Cancer

“…To puncture the lungs in vivo may cause lethal complications such as air embo lism or pleural dissemination. 18) Even after thoracotomy, puncture of the lung has a possibility to cause such com plications. Before this paper, there had been no reports supporting the benefit of measuring IFP for lung cancer; therefore, in this study, we measured the IFP only after resection.…”

Intraventricular Air Embolus Causing Ischemic Stroke after Lung Biopsy

“…First, if the tip of the biopsy needle is lodged in a pulmonary vein and the inner stylet is removed, air embolism can occur during rapid inspiration when the atmospheric pressure exceeds the pulmonary venous pressure. Second, when a needle simultaneously traverses an air-containing space (airway for example) and adjacent pulmonary vein, a fistula can occur and air will enter the vein when the alveolar air pressure is greater than the pulmonary venous pressure -for example while coughing [12]. From pulmonary veins the gas could travel to the left heart.…”