Pneumothorax post CT-guided lung biopsy: a comparison between detection on chest radiographs and CT.

Abstract

Pneumothorax is reported to be a more common complication of lung biopsy performed under computed tomography (CT) than under fluoroscopic guidance. This may simply reflect the greater sensitivity of CT over chest radiographs (CXRs) in the detection of small pneumothoraces. This study aimed to determine the incidence of pneumothorax detected by CXR and by CT after CT-guided biopsy of non-pleurally based pulmonary masses, and to compare these incidences with previous reports in the literature of pneumothorax incidence post fluoroscopic biopsy. 88 consecutive CT-guided lung biopsies of masses not abutting the pleural surface were included. Immediate post-biopsy CT images, and 1 and 4 h CXRs were assessed independently by two observers for the presence and size of pneumothorax. 72 biopsies were fine needle aspirations (FNAs) performed with 22 G spinal needles only, seven were cutting needle biopsies (CNBs) performed with 18 G cutting needles only, and nine were both. 37 patients (42%) developed a pneumothorax. 35 were detected on CT (40%) and 22 on CXR (25%). None required tube drainage. Of the patients in whom CT demonstrated a pneumothorax, the average depth of this was significantly greater for those in whom CXR also detected a pneumothorax compared with those in whom CXR was negative (7.3 mm versus 3.4 mm, p < 0.05). The incidence of pneumothorax detected on CXR post CT-guided biopsy is similar to the reported incidence post fluoroscopic biopsy.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

“…Computed tomography (CT) is more sensitive than chest radiographs in the detection of pneumothorax [43][44][45][46]. However, it is not required in the majority of cases, as the diagnosis may be clearly made on a chest radiograph and an excess radiation dose should be avoided in this young patient population [47].…”

Guidelines for radiologically guided lung biopsy

“…Between 3.3% and 15% of all patients will require a chest drain. [9][10][11][12][13][14][15] This large range for pneumothorax reflects both altered risk from the location of the lesion and the increased sensitivity of CT, and potentially ultrasound, to detect very small pneumothoraces which may be overlooked on the chest radiograph.…”

CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance

“…Computed tomography (CT)-guided percutaneous needle aspiration biopsy (NAB) of the lung is a well-established method of cytologically diagnosing pulmonary nodules [1][2][3][4]. However, CT provides limited guidance for interventions because it is not conducted in real-time like conventional fluoroscopy or ultrasound (US).…”