Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy

Lc, Zeng; Du, Yuchen; Hf, Yang; Mg, Xie; Hq, Liao; Yd, Zhang; L, Li; Q, Wang; Hu, Liang; Xu, Xiao

doi:10.1259/bjr.20150227

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…In cases where aspiration was unsuccessful, the patient was reversed to the side opposite the biopsy puncture site, and aspiration was repeated, which was successful in six out of the remaining seven patients. Zeng et al 44 reported an “opposite position aspiration (from prone to supine or vice versa)” in a larger study sample with an encouraging result. Eighty-two pneumothorax patients were treated with simple manual aspiration that was successful in 58 (70.7%) cases.…”

Section: Management Strategiesmentioning

confidence: 89%

“…The pathophysiologic basis for this is likely due to many factors. 44 biopsy side down positioning for aspiration may be beneficial for the visceral and parietal pleura symphysis and accumulation of blood within the needle tract, which creates a physical barrier to further leakage of air. This procedure does not increase the alveolar-to-pleural pressure gradient surrounding the leak region compared to aspiration near the initial biopsy site ( Figure 1 ).…”

Section: Management Strategiesmentioning

confidence: 99%

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Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Zeng

Liao

Ren

et al. 2021

IJGM

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Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a valuable procedure for obtaining tissue or cells for diagnosis, which is especially indispensable in thoracic oncology. Pneumothorax and hemoptysis are the most common complications of percutaneous needle biopsy of the lung. According to reports published over the past decades, pneumothorax incidence in patients who underwent TTNB greatly varies. The morbidity of pneumothorax after CT-guided TTNB depends on several factors, including size and depth of lesions, emphysema, the number of pleural surfaces and fissure crossed, etc. Attention to biopsy planning and technique and post-biopsy precautions help to prevent or minimize potential complications. Many measures can be taken to help prevent the progression of a pneumothorax, which in turn might reduce the number of pneumothoraces requiring chest tube placement. A multitude of therapeutic options is available for the treatment of pneumothorax, varying from observation and oxygen treatment, simple manual aspiration, to chest tube placement. When a pneumothorax develops during the biopsy procedure, it can be manually aspirated after the needle is retracted back into the pleural space or by inserting a separate needle into the pleural space. Biopsy side down positioning of the patient after biopsy significantly reduces the incidence of pneumothorax and the requirement of chest tube placement. Aspiration in biopsy side down position is also recommended for treating pneumothorax when simple manual aspiration is unsuccessful or delayed pneumothorax occurred. Chest tube placement is an important treatment strategy for patients with a large or symptomatic pneumothorax. Clinicians are encouraged to understand the development, prevention, and treatment of pneumothorax. Efforts should be made to reduce the incidence of pneumothorax in biopsy planning and post-biopsy precautions. When pneumothorax occurs, appropriate treatment should be adopted to reduce the risk of worsening pneumothorax.

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Section: Management Strategiesmentioning

confidence: 89%

Section: Management Strategiesmentioning

confidence: 99%

Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Zeng

Liao

Ren

et al. 2021

IJGM

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“…The mainly three mechanisms which allow air to enter the pleural space are communication with the outside atmosphere, visceral pleural rupture and the presence of gas-producing organisms (18)(19)(20)(21). And the first two factors A B may contribute to lung biopsy-induced pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…And the first two factors A B may contribute to lung biopsy-induced pneumothorax. An unskilled biopsy may cause direct or indirect communication between the atmosphere and the pleural space, visceral pleural rupture is considered to be the most important contributing factor in lung biopsy-induced pneumothorax especially for pneumothorax in moderate to large in volume (21). The manual aspiration of a pneumothorax was initially reported by Yamagami et al (22) as a method of preventing an increased pneumothorax that would require chest tube placement.…”

Section: Discussionmentioning

confidence: 99%

Manual aspiration in the biopsy-side down position to deal with delayed pneumothorax after lung biopsy

Zeng

Yang

et al. 2018

J. Thorac. Dis.

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Background:To assess the effect of aspiration in the biopsy-side down position to deal with delayed pneumothorax after computed tomography (CT)-guided lung biopsy.Methods: A retrospective review was performed of the 236 delayed pneumothorax patients who underwent CT-guided transthoracic needle biopsies (TTNBs). Asymptomatic minimal pneumothorax patients were managed conservatively. Manual aspirations were applied for symptomatic cases with minimal pneumothorax and all cases with moderate to large pneumothorax. Patients were included into two groups: in group A (35 patients), aspiration was performed in the same position as the biopsy, while in group B (54 patients), patients were turned to the biopsy-side down position (from supine to prone or vice versa), and aspiration was conducted. The efficacy of two approaches was evaluated.Results: One hundred forty-seven (62.3%) asymptomatic cases resolved without treatment. Distance between parietal and visceral pleura before and after aspiration were 4.24±1.87 and 1.93±2.33 cm for group A, 3.92±1.31 and 0.98±1.50 cm for group B, respectively. Volume of aspirated air in group A and group B were 735.4±231.8 and 434.8±320.3 mL, respectively. Complete lung expansion was detected in 28.6% (10/35) and 38.9% (21/54) for group A and group B, respectively. The overall effective rate and failure rate were 74.3% (26/35) and 25.7%(9/35) for group A, 92.6% (50/54) and 7.4%((4/54)(for group B, respectively, which have significant statistic difference (P<0.05).Conclusions: Manual aspiration in biopsy-side down position demonstrates the safety and efficacy in treating delayed pneumothorax after CT-guided TTNBs. Thus reduce the rate of pneumothorax requiring drainage catheter placement. (4,5). Simple aspiration and tube thoracostomy were recommended to deal with the pneumothorax. As reported, tube thoracostomy is associated with more complications and resulted in a longer stay in hospital than simple aspiration (6). Many previous reports have shown that increasing delayed pneumothoraces often need chest tube placement. Patient positioning after biopsy has been studied but remains controversial, some study found that placing the patients biopsy-side down (from prone to supine or vice versa) after biopsy substantially reduced the rate of pneumothorax (5,7), while some other articles found no effect (8,9). Anecdotally, we noted in practice some satisfactory results were achieved by using aspiration in biopsy-side down position. We reported our preliminary experience using a modified manual aspiration in the biopsy-side down position in an attempt to deal with delayed pneumothorax caused by biopsy, thus reduce the application of tube thoracostomy significantly. MethodsThis retrospective study was approved by the Ethical Committee and Institutional Review Board of Affiliated Hospital of North Sichuan Medical College (No. NSMC1601-018). A retrospective review was performed of the clinical records and radiological findings of 1750 consecutive patients who underwent CT-guided TTNB for lung le...

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Effect of puncture sites on pneumothorax after lung CT-guided biopsy

Zeng¹,

Liao²,

Wu³

et al. 2020

Medicine

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To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy. Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed. Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure. Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.

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Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy

Cited by 3 publications

References 23 publications

Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Manual aspiration in the biopsy-side down position to deal with delayed pneumothorax after lung biopsy

Effect of puncture sites on pneumothorax after lung CT-guided biopsy

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