Pneumothorax after Computed Tomography-Guided Lung Biopsy: Utility of Immediate Post-Procedure Computed Tomography and One-Hour Delayed Chest Radiography

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Jared Weinand, MD

Radiology Resident
University of North Carolina Hospitals

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Jd

Johannes du Pisanie, Jr., MD (he/him/his)

Integrated Interventional Radiology Resident
UNC School of Medicine
SN

Smith Ngeve, n/a

Medical Student
UNC School of Medicine
CC

Clayton Commander, MD, PhD

Assistant Professor
UNC Hospitals
Hyeon Yu, MD FSIR

Professor
University of North Carolina At Chapel Hill

Disclosure(s):

Jared Weinand, MD: No financial relationships to disclose

Johannes du Pisanie, MD, Jr.: No financial relationships to disclose

Clayton Commander, MD, PhD: W.L. Gore & Associates: Speaking and Teaching (Ongoing)

Hyeon Yu, MD FSIR: No financial relationships to disclose

Purpose:

To evaluate the utility of immediate post-procedure computed tomography (IPP-CT) and one-hour chest radiography (1HR-CXR) for detecting/managing pneumothorax after computed tomography (CT)-guided lung biopsy.

Materials and Methods: All CT-guided lung biopsies between May 2014 and August 2021 were included. 275 procedures were performed on 267 patients who underwent 1HR-CXR were reviewed. Incidences of pneumothorax and other complications on IPP-CT and 1HR-CXR were recorded. Associated variables were analyzed and compared between groups with and without pneumothorax.

Results: Complications were pneumothorax (30.9%, 85/275) and hemoptysis (0.7%, 2/275). Pneumothorax was detected on IPP-CT and 1HR-CXR in 89.4% (76/85) and 100% (85/85), respectively. A chest tube was placed in 4% (11/275) of cases. In 3.3% (9/275) of cases, pneumothorax was detected only on 1HR-CXR, but no patient in this group necessitated chest tube placement. Incidence of pneumothorax did not differ between tract embolization methods, needle diameters and types, access sites, and lesion sizes. On logistic regression, lower biopsy sample number (OR = 0.49) was protective, and longer needle tract distance (OR = 1.16) was a risk factor for pneumothorax.

Conclusion: After CT-guided lung biopsy, pneumothorax detected on IPP-CT strongly predicts persistent pneumothorax on 1HR-CXR and possible chest tube placement. If no pneumothorax is seen on IPP-CT, follow-up 1HR-CXR may be required only for those who develop symptoms of pneumothorax.