1Muktachand Rokade, 1Amol Kulkarni

1Jupiter Hospital, Thane, India

 

Background:

Image guided transthoracic lung biopsy is a widely accepted technique for the workup of lung lesions. Screening for lung cancer and the growing need for research biopsy samples will continue to increase the demand for image guided lung biopsy. With the widespread use of cross sectional imaging and multidetector CTs, most centers have shifted their practice to performing lung biopsies under CT guidance.

Pneumothorax is the most common complication of transthoracic lung biopsy. A patient with stable pneumothorax may be treated conservatively without chest tube insertion. If pneumothorax is large (greater than 30% of hemithorax), is rapidly expanding, or is causing symptoms, chest tube insertion is warranted. The reported rates of pneumothorax and chest tube placement vary greatly in the published literature. In some of the larger series, pneumothorax was encountered in 20-25% of patients, and chest tube was inserted in 0% to 17% of patients. This leads to increased patient discomfort and increased cost of the investigation.

This was single center institutional review to evalaute the incidence of pneumothorax post lung lesion biopsy and assessment of efficacy of the autologuous blood clot seal.

Material(s) and Method(s):

A total of 54 patient who underwent CT guided lung biopsy from July 2018 to April 2019 were included in this clinical audit. Pre procedural work up was performed in all patients.

Each patient underwent a percutaneous lung biopsy using conventional CT scan guidance with a co-axial image. Each patient was placed in the prone or supine position during the procedure.After obtaining the core biopsy samples autologuous blood clot seal was used to plug the biopsy tract.

Post procedure check CT was performed to detect pneumothorax.

Result(s):

The incidence of pneumothorax was less than 2% in our study population which is much less than found in literature. This is attributed to the stringent safety protocol followed viz patient selection and preparation, single puncture technique short distance to the lesion and use of autologous blood patch.

Conclusion(s):

Lung biopsy should be planned carefully to select the shortest path to the lesion while avoiding multiple punctures of the pleural linings or traversing emphysematous lung parenchyma.

Use of autologuous blood clot to seal the biopsy tract significantly reduces the incidence of pneumothorax.