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

Zeng, Lichuan; Yang, Hua-Yuan; Xu, Xiaoxue; Xie, Mingguo; Liao, Huaqiang; Zhang, Yudong; Wang, Qu; Du, Yuchen

doi:10.21037/jtd.2017.12.03

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…The patient who had delayed pneumothorax was treated with thoracic close drainage and recovered in a week. Manual aspiration in the biopsy-side down position may reduce the rate of delayed pneumothorax according to a study (18). The other 5 patients with pneumothorax recovered in 1 week.…”

Section: Discussionmentioning

confidence: 99%

“…The 20 cases in which USLB could not obtain lung tissue were those of lung abscess, pneumonia, lung cancer and idiopathic interstitial pneumonia. In the cases of lung abscess, lung cancer or severe pneumonia, there could be a large range of [11], organized lesions [11], idiopathic interstitial pneumonia [10], bronchiolitis obliterans with organizing pneumonia [1], interstitial pneumonia secondary to autoimmune disease [4], pulmonary sarcoidosis [4], eosinophilic bronchitis [2], lung abscess [9], pulmonary atelectasis [1], pleuroparenchymal fibroelastosis [1], unidentified and self-cured [18], unidentified and stable for over 6 months [10], Wegener's granulomatosis [1], acute fibrinous and organizing pneumonia [ [10], non-small cell lung cancer not otherwise specified [3], metastatic tumour [13], neuroendocrine carcinoma [4], adenosquamous carcinoma of the lung [2], pulmonary lymphoma [7], epithelioid angiosarcoma of lung [1], lung sarcomatoid carcinoma [6] Immune disease (5 cases) Lipoid pneumonia [2], IgG4-related disease [2], pulmonary alveolar proteinosis [1] Compound disease (7 cases) Lung cancer with special infection [6], metastatic tumour with special infection [1] Other (3 cases) Pulmonary infarction [3] USLB, ultrasound-guided lung biopsy.…”

Section: Discussionmentioning

confidence: 99%

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The accuracy of ultrasound-guided lung biopsy pathology and microbial cultures for peripheral lung lesions

Zhao¹,

Peng²,

Wei³

et al. 2020

J Thorac Dis

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Background: Ultrasound-guided lung biopsy (USLB) is a minimally invasive, real-time, safe and effective way to diagnose peripheral lung lesions. USLB is now widely used in clinical practice. However, the accuracy of USLB lacks large sample studies, and specimens from USLB are seldom used for microbial cultures. In this study, the efficiency of diagnosing tumours and infectious diseases with USLB is investigated, and the safety of USLB is evaluated.Methods: From September 2015 to August 2018, a total of 507 cases of USLB were retrospectively reviewed, including the pathological results, microbial culture results and complications. The final diagnosis was confirmed by clinical diagnosis and follow-up. The technical success rate and accuracy of USLB were calculated.Results: Six patients were excluded because they were lost to follow-up. A total of 501 patients were finally included (335 males and 166 females). The diagnostic accuracy of USLB was 82.0%. The accuracy of USLB in diagnosing lung tumours was 88.5% and that for diagnosing special infections was 55.2%. The positive rate of USLB lung tissue cultures was 18.3%. USLB can diagnose some microbial infections with high accuracy, such as mycobacterial infections, and Cryptococcus neoformans, Aspergillus fumigatus and Burkholderia cepacia infections.Conclusions: USLB is a safe and effective method for diagnosing peripheral lung lesions with high accuracy and a low complication rate. Lung tissue pathology and cultures have good diagnostic value for tuberculosis and fungi infections. Lung tissue cultures can also diagnose bacterial infections and can contribute to the selection of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The accuracy of ultrasound-guided lung biopsy pathology and microbial cultures for peripheral lung lesions

Zhao¹,

Peng²,

Wei³

et al. 2020

J Thorac Dis

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show abstract

“…Although some studies have reported that biopsy side down position may not affect the incidence of post-biopsy pneumothorax, [27][28][29] much more investigators have reported favorable results. [30][31][32] Kinoshita et al 33 performed the lung biopsy with a puncture site down position through a window in the CT bed. Although this approach was useful in reducing the rate of pneumothorax, it was not widely utilized because it was ergonomically difficult for the operator as it requires needle manipulation from below the CT bed.…”

Section: Biopsy/puncture Site Down Position or Rollover Techniquementioning

confidence: 99%

“…Pneumothorax that develops 3 or 4 hours after TTNB has been defined as delayed pneumothorax in some reports, 13 , 46 while other authors suggest that pneumothorax should be considered as “delayed” when it was first detected in follow-up after biopsy. 30 The risk factor, reason and mechanism of the delayed presentation of pneumothorax are not well known. It is speculated that immediate or delayed occurrence of pneumothorax depends on the severity of injury, the speed of air leakage, and expansibility of the targeted lung and overlying pleura.…”

Section: Management Of Delayed Pneumothoraxmentioning

confidence: 99%

“…The influence of puncture site on aspiration as an initial treatment for biopsy-induced delayed pneumothorax is interesting. Zeng’s study 30 demonstrated that aspiration in the biopsy-side down position had an encouraging result compared to aspiration on the same side as the biopsy. They included 35 patients in group A, for whom aspiration was performed in the same position as the biopsy, and 54 patients in group B, for whom aspiration was performed after biopsy-side down positioning.…”

Section: Management Of Delayed Pneumothoraxmentioning

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

Self Cite

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

Cited by 4 publications

References 22 publications

The accuracy of ultrasound-guided lung biopsy pathology and microbial cultures for peripheral lung lesions

The accuracy of ultrasound-guided lung biopsy pathology and microbial cultures for peripheral lung lesions

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

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

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