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delayed pneumothorax after lung biopsy

Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. The disruption of dilated air spaces and the lack of elastic recoil in emphysematous lung may prevent rapid sealing of the air leak, resulting in early manifestations of pneumothorax [32, 33]. Therefore, the incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. In univariate analysis, the pneumothorax group had smaller lesions (p < 0.001), middle/lower lobe location (p = 0.001), longer intrapulmonary needle track (p = 0.002), increased number of pleural punctures (p = 0.02), and emphysema (p = 0.009), compared to the group without pneumothorax. May 27, found a significantly higher risk of immediate pneumothorax in patients with emphysema [17]. By continuing you agree to the Use of Cookies. pmid:15539721 . To read this article in full you will need to make a payment. In all patients, the platelet count exceeded 100,000/ μL, and the prothrombin time and activated partial prothrombin time were within normal limits. However, lobar location of the lesion was the most powerful variable in each group. Competing interests: No authors have competing interests. Delayed pneumothorax has been also reported as a complication of transbronchial lung biopsy, 14 and of subclavian vein catheterization. Choi CM, Um SW, Yoo CG, et al. Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure and pneumothorax is the most frequently associated adverse event. Emphysema and long intrapulmonary needle track were not risk factors for delayed pneumothorax. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Seventeen patients, including 3 patients with delayed pneumo- Among variables contributing to the risk of pneumothorax, factors other than small lesion size remain controversial [9, 19, 21–24]. PMCID: PMC1758585 The position of the needle tip was confirmed by obtaining limited CT images of 3–5 mm thickness around the lesion. In the present study, the number of pleural punctures was related only to delayed pneumothorax. The requirements for written informed consent were waived owing to the retrospective nature of the study. The second most powerful variable was emphysema in affected lobe in immediate pneumothorax and the number of pleural punctures in delayed pneumothorax. patient (18 months post-lung transplant) developed delayed pneumothorax 5 months after TBB.9 Table 1 provides an overview of reported cases of delayed pneumothoraces following transbronchial biopsies. devices, and underlying diseases were not correlated with the delayed pneumothorax PLOS ONE promises fair, rigorous peer review, Acute respiratory distress syndrome and pneumothorax. Factors related to patients, lesions, and procedures were compared via bivariate analyses using the two-sided Student’s t-test or Mann-Whitney U test for numeric values and chi-square test for categorical values. In the contrary, immediate pneumothorax that is persistent on follow-up chest radiograph and delayed pneumothorax may represent continuous air leak, thus often requiring chest tube drainage. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. Thorax 1997; 52:581-582. An 18-gauge core needle (Bard Magnum, Covington) with an automated biopsy gun was used in all cases. Therefore, it is speculated that pneumothorax appears immediately or later in CTLB depending on the speed of air leakage, which is affected by intactness of elastic recoil, the severity of injury, and expansibility of the targeted lung and overlying pleura. No, Is the Subject Area "Emphysema" applicable to this article? 1 Introduction. Conceptualization, Project administration, Pneumothorax was considered to be “delayed” when it was first detected in follow-up chest radiographs after biopsy. CTLB, Pleural injury involving lower lobes with higher aeration and ventilatory movement may lead to early appearance of pneumothorax. Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. Delayed pneumothorax group had smaller lesion (p < 0.001), upper lobe location (p = 0.02), and increased number of pleural punctures (p < 0.001), compared to the group without pneumothorax (Table 1). There were 372 males and 164 females with a mean age of 65.8 (range, 18–90) years. Link, Google Scholar Manual aspiration in biopsy-side down position demonstrates the safety and efficacy in treating delayed pneumothorax after CT-guided TTNBs. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Among them, 9 cases were in immediate group and 5 cases were in delayed group. Such delayed pneumothorax after lung biopsy is extremely unusual. Supervision, Delayed pneumothorax after transbronchial lung biopsy. Writing – original draft, Chest. Only 40.7% of immediate pneumothorax remained in initial follow-up chest radiographs and 12.7% of those cases required chest tube placement. Writing – review & editing. Ground-glass opacity; OR, absence of an emphysematous change were identified as risk factors for delayed pneumothorax. 2004, Received: of an emphysematous change, biopsy guidance methods, and biopsy devices were analyzed. Meanwhile, the elastic recoil of the normal lung parenchyma and pleura over the lesion may seal the small opening of the pleura initially to prevent pneumothorax [17]. When comparing chest tube insertion rates between immediate pneumothorax that was persistently shown on initial follow-up chest radiographs (7/55, 12.7%) and delayed pneumothorax (5/26, 19.2%), the difference was not significant. With small size of pneumothorax and inconspicuous dyspnea, the patients may be taken oxygen therapy and close observation. Pneumothorax Data curation, Odds ratio; CI, Project administration, The factors that were significant in the bivariate analyses were used as variables in multivariate logistic regression to identify independent risk factors for pneumothorax. After exclusion of 42 patients (28 with pleural or mediastinal lesions, nine with multiple lung biopsy during the same admission period, three with ipsilateral chest tube insertion, and two cases of technical failure), 536 patients who underwent lung biopsy were enrolled. Risk factors for pneumothorax after transthoracic lung biopsy have been examined widely. Personal Information Authors: https://doi.org/10.1371/journal.pone.0238107.t003. Study objectives: To evaluate the incidence and clinical significance of delayed pneumothorax, and to analyze the influence of multiple variables on the rate of delayed pneumothorax associated with transthoracic needle biopsy (TTNB) of the lung. Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. Third, immediate and delayed pneumothorax was detected in CT and chest radiographs, respectively. 2004;126:1516–21. Validation, CT-guided transthoracic lung biopsy; CT, with transthoracic needle biopsy (TTNB) of the lung. Patients should be warned of the possible occurrence of this complication and instructed to seek medical help if they develop chest pain or breathlessness. Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. For more information about PLOS Subject Areas, click Rates of chest tube insertion were also compared. Most previous studies regarding pneumothorax have focused on incidence rates and overall risk factors. Other proposed mechanisms and associated risk factors that are known to contribute to the development of delayed pneumothorax include absence of emphysematous changes in the lung parenchyma, persistence of a tissue flap after biopsy (obstructing the air flow), and microbial seeding through the puncture site. CONCLUSIONS: The incidence of delayed pneumothorax was 3.3% of all TTNBs. Significance of lesion location on delayed pneumothorax has not been demonstrated due to sparsity of related studies. reported similar results in which only 38% of CT detected pneumothorax showed persistence in follow-up chest radiographs at 4 h after biopsy and 21% of them required chest tube drainage [20]. Conversely, emphysema was an independent variable related only to immediate pneumothorax; and the results were consistent with previous studies [17, 19]. https://doi.org/10.1371/journal.pone.0238107.s001. These patients were followed up 1 day and/or 1 week after biopsy to identify delayed complications. catheter or chest tube. Choi C-M, Um S-W, Yoo C-G, Kim YW, Han SK, Shim Y-S, et al. For more information about PLOS Subject Areas, click reported that the left upper lobe location was an independent risk factor for pneumothorax, in contrast to other studies, with delayed pneumothorax contributing to about one-third (66/253, 29.6%) of total pneumothorax in their study group [21]. More than half of immediate pneumothorax was resolved quickly. Such delayed pneumothorax after lung biopsy is extremely unusual. Therefore, lesion location as a risk factor for delayed pneumothorax may differ from that in previous studies in which all cases of pneumothorax were included regardless of the onset time. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting Information file. Methodology, The initial follow-up chest radiograph taken at 4 h after procedure revealed persistence of immediate pneumothorax in 55 of 135 cases (40.7%). We did not routinely acquire chest radiographs earlier than 4 h after procedure. Pneumothorax developed in 100 of the 458 patients (21.8%), and delayed pneumothorax developed in 15 patients (3.3%). Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. 12 cases (12/26, 46.2%) of delayed pneumothorax were detected on the initial follow-up chest radiograph. Several studies have suggested auxiliary … Female Crossref, Medline, Google Scholar; 18 Moore EH, LeBlanc J, Montesi SA, Richardson ML, Shepard JA, McLoud TC. However, this is common practice pattern in CTLB since it is not practical to obtain chest radiographs immediately after biopsy CT [20, 34]. Only a few studies have given attention to the developing time of pneumothorax [17–19]. reported their experience with two cases of pneumothorax occurring 26 and 36 hours after the procedure, in which each target lesion was located in the left and the right upper lobes, respectively [13]. DOI: https://doi.org/10.1378/chest.126.5.1516. Outpatient management of pneumothorax after fine-needle aspiration: economic advantages for the hospital and patient. In many institutions, biopsy is performed as an outpatient procedure with early discharge [15, 16]. Pneumothorax developed in 100 of the 458 patients (21.8%), and delayed pneumothorax developed in 15 patients (3.3%). https://doi.org/10.1371/journal.pone.0238107, Editor: Muhammad Adrish, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, NY, USA, UNITED STATES, Received: June 23, 2020; Accepted: August 10, 2020; Published: August 24, 2020. Effective monitoring of patients after procedure requires detection of patients who are at risk of delayed development of pneumothorax. A chest radiograph is obtained after 3 hours to exclude a delayed pneumothorax. Such delayed pneumothorax after lung biopsy is extremely unusual. A pneumothorax that developed after 3 hours was defined as delayed pneumothorax. e0238107. broad scope, and wide readership – a perfect fit for your research every time. Differences were considered significant at p < 0.05. We use cookies to help provide and enhance our service and tailor content and ads. After removing the biopsy needle, post-procedure check CT was obtained with the patient in a supine position to detect any complications. Data curation, Yes In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). and 157 ultrasonography-guided lung biopsies were performed. The procedures were performed with patients in prone, supine, oblique, or lateral decubitus positions depending on lesion location. Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. The procedure however comes with inherent risks, the most common being bleeding and pneumothorax. Methodology, A routine immediate post-procedure CT scan (ICT) to spot PNX is done in many centers. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung From CHEST, 11/1/04 by Chang-Min Choi. low. The cumulative incidence of pneumothorax according to the time of detection is presented in Table 2. https://doi.org/10.1371/journal.pone.0238107.t002. Conversely, pulmonary air in the upper lobes with less movement may escape slowly, resulting in late appearance of pneumothorax. Citation: Bae K, Ha JY, Jeon KN (2020) Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence. A follow-up chest radiograph was obtained immediately and at 3, 8, and 24 hours after the biopsy procedure. Patients with a symptomatic or enlarging pneumothorax were treated with an 8-F pigtail catheter attached to a Heimlich valve, discharged, and … Delayed pneumothorax was defined as pneumothorax developed after the biopsy needle is removed. pneumothorax, required a pigtail catheter or a chest tube insertion. No, Is the Subject Area "Computed axial tomography" applicable to this article? Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Subsequently, patients were monitored in the parent department for at least three hours to detect any delayed complication. '-' Wereport The incidence of delayed pneumothorax as a complication of subclavian vein catheterisation. was obtained immediately, and 3 h, 8 h, and 24 h after the biopsy procedure. In conclusion, pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. No, Is the Subject Area "Biopsy" applicable to this article? Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea, Yes Investigation, Written informed consent was obtained from all patients before undergoing procedures. Writing – original draft, Patients should be warned of the possible occurrence of this complication and instructed to seek medical help if they develop chest pain or breathlessness. Radiology 1997; 205:249-252. Copyright: © 2020 Bae et al. analyze the influence of multiple variables on the rate of delayed pneumothorax associated Such results imply that a significant number of cases with immediate pneumothorax represent transient air leak via needle insertion site and resolve quickly when small pleural blood clots formed. While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172–3.344, OR = 3.505; CI = 2.718–5.650, and OR = 1.330; CI = 1.132–1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634–20.274 and OR = 3.738; CI = 1.860–7.511, respectively) for delayed pneumothorax. Mills et al. After puncturing the skin, the patients were instructed to hold their breath at a normal expiration and the pleural puncture was subsequently made. In the present study, delayed pneumothorax showed higher requirement of chest tube drainage, than immediate pneumothorax (19.2% vs. 6.7%). This study was approved by Institutional Review Board of Gyeongsang National University Changwon Hospital. 2003. catheterization (22%), thoracentesis (20%), a transbronchial lung biopsy (10%), pleural biopsy (8%) and positive pressure ventilation (7%) . Between March 2010 and September 2015, 578 consecutive patients underwent CT-guided transthoracic biopsy conducted by two thoracic radiologists (with 16 and 7 years of experience in image-guided biopsy). Female gender and the Adult patients underwent TTNB from June 2001 to June 2002. Patients were asked to lie with the puncture site down and coughing and ambulation was discouraged for the first 4 h. Inspiration upright posteroanterior chest radiograph was routinely performed at 4 h after procedure and prior to discharge. that had not developed up to 3 h but developed later was defined as a delayed pneumothorax. No, Is the Subject Area "Medical risk factors" applicable to this article? Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. View Article PubMed/NCBI Google Scholar 25. One hundred and thirty-nine participants were referred for CT-guided percutaneous lung biopsy, and 81 were … 14. Yes Among the known risk factors, some are consistent whereas others are inconsistent or even contradictory across published studies, probably owing to various baseline characteristics, biopsy techniques, and analytic methods [8–12]. To evaluate the incidence and clinical significance of delayed pneumothorax, and to developed in 15 patients (3.3%). Brown KT, Brody LA, Getrajdman GI, et al. No, Is the Subject Area "Pleurae" applicable to this article? With large size of pneumothorax or pneumomediastinum, patients should need more active treatment, including chest tube drainage. If the patient develops pneumothorax during a transthoracic needle biopsy (TNB), they will be observed for several hours. 3–5 While delayed pneumothorax has been previously reported, our report is unique due to the magnitude of elapsed time between the transbronchial biopsy and the development of the pneumothorax, and the clear evolution … Post-biopsy radio- graphs are used to exclude pneumothorax, one of the most common major complications. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage. However, since immediate and delayed pneumothorax were detected using different modalities, chest tube insertion rates between the two groups should not be directly compared. Age, gender, type of lesion, pleural puncture angle, pathological results, and needle indwelling time did not show any differences between groups with and without pneumothorax. of delayed pneumothorax (p < 0.05). Lesion size, location, biopsy guidance methods, devices, and underlying diseases were not correlated with the delayed pneumothorax rate. J Thorac Dis 2014;6:S443-7. If the procedure has been performed on an outpatient basis, the patient can be discharged home on the same day. Reducing this risk is a goal of those who perform these procedures, particularly a reduction in large pneumothoraces requiring intervention (eg, pleural drainage) and … Conclusion: Obtaining a routine follow-up CXR in all patients after CT-guided lung biopsy appears warranted, given the high rate of delayed pneumothorax and large percentage of patients who will require a chest tube. Full Text. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. A study by Choi et al. Fourth, immediate and non-immediate pneumothorax was considered mutually exclusive but both events possibly occurred in a same patient. The purpose of this study was to determine the risk factors and clinical significance of delayed pneumothorax after CTLB, compared to those of immediate pneumothorax. 14 cases was identified more than 4 h after biopsy. here. Patients with a symptomatic or enlarged pneumothorax were treated using a pigtail Conceptualization, Is the Subject Area "Pneumothorax" applicable to this article? We report a lung transplant patient who developed a pneumothorax 5 months after transbronchialbiopsy.Multipleinterveningchestcomputed tomograms (CTs) document that the pneumothorax devel- oped from the biopsy site. Delayed pneumothorax is extremely rare and can occur from a number of different procedures, either directly or inadvertently involving the lung. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea, Correspondence to: Choon-Taek Lee, MD, PhD, Department of Internal Medicine and Respiratory Center, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463–707, Korea. Writing – review & editing, Roles They include 135 cases (83.9%) of immediate pneumothorax and 26 cases (16.1%) of delayed pneumothorax. Delayed pneumothorax after central venous access: a potential hazard. Fourteen of 161 cases (8.7%) of pneumothorax required chest tube or drainage catheter placement. Radiology 1991; 181:385-387. In contrast, the absence of an emphysema correlated with an increased rate of delayed pneumothorax. Click through the PLOS taxonomy to find articles in your field. By continuing you agree to the, Incidence and Risk Factors of Delayed Pneumothorax After Transthoracic Needle Biopsy of the Lung, picture archiving and communication system. PubMed Article Google Scholar The rate of chest tube insertion was significantly higher in delayed group (19.2%) than in immediate group (6.7%) (P < 0.001). In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). assessing risk factors for delayed pneumothorax failed to demonstrate the significance of lesion location as a contributing factor [17]. The only independent predictor of (symptomatic) delayed pneumothorax was the length of intrapulmonary needle tract. After biopsy, all patients were placed in the decubitus position to compress the biopsy site. Therefore, clinical significance of delayed pneumothorax may be similar to that of immediate pneumothorax that is shown on initial follow-up chest radiograph obtained 4 h after procedure. Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea, Roles In multivariate analysis, lesion size (odds ratio [OR] = 0.779; 95% confidence interval [CI] = 0.690–0.878), middle/lower lobe location (OR = 2.344; CI = 1.524–3.610), long intrapulmonary biopsy track (OR = 1.25; CI = 1.139–1.541), increased number of pleural punctures (OR = 1.604; CI = 1.153–2.235), and presence of emphysema in affected lobe (OR = 2.042; CI = 1.255–3.322) were risk factors for pneumothorax (Table 3). Yes Lower lobe location is known to be a risk factor for pneumothorax owing to the greater mobility of lower lobes [25–28]. 1, 9 Occasional delayed pneumothoraces have been reported more than 24 hours after biopsy, despite the absence of a pneumothorax on chest radiographs taken 4 hours after biopsy. If no major complications were detected, patients were discharged within 24 h after admission. Methodology, Outpatient Treatment of Iatrogenic Pneumothorax after Needle Biopsy. After completion of tissue sampling, all patients underwent immediate CT scanning on the table to detect procedure-related complications. 15, 16 Our prospective study shows that the delayed pneumothorax rate was 3.3% (15 of 496 procedures) in … Subsequent weakening of elastic recoil or multiple openings in normal pleura by multiple punctures may facilitate late presentation of pneumothorax. Pneumothorax is the most common complication of percutaneous lung biopsies. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. Delayed PTX post TBB presenting as a tension PTX … Data curation, In other studies involving delayed pneumothorax, the proportion ranged from 7.1% to 29.6% of the overall rate of pneumothorax [17–21]. To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to … Investigation, J Thorac Dis 2014;6:S435-42. Aspiration needle biopsy of thoracic lesions. The demand for lung biopsy is growing due to an increase in detection of lung tumor in screening and the need for molecular and genomic profiling of non-small cell lung cancer [1–3]. Therefore, each pneumothorax group was compared with the non-pneumothorax group. In 7 cases, tube insertion was conducted after the initial 4 h follow-up chest radiographs. To evaluate the rate of iatrogenic pneumothorax and the need for intervention with extrapleural autologous blood injection (EPABI) along with intraparenchymal autologous blood patch injection (IABPI) or IABPI-only in CT-guided percutaneous lung biopsy. or chest tube insertion rate in delayed pneumothorax was 20% (3 of 15 patients). Pneumothorax after transbronchial needle biopsy. Further studies with larger populations are required to corroborate our results. The hemothorax did not appear until 48 hours later and was accompanied by enlargement of the pneumothorax.The delayed occurrence of intrapleural hemorrhage makes it unlikely that the transbronchial … Variables such as age, gender, lesion size, location, presence Of all cases of pneumothorax, 16.1% was delayed occurrence. gender and the absence of an emphysematous change correlated with an increased rate Confidence interval. Chest. Our study showed small lesion size as the only consistent factor related to both immediate and delayed pneumothorax. The pneumothorax complicating bronchoscopic transbronchial lung biopsy in our patient was identified at the time of the procedure and was clearly iatrogenic. Noninvasive Ventilation by Helmet or Face Mask in Immunocompromised Patients, We use cookies to help provide and enhance our service and tailor content and ads. PLoS ONE 15(8): All biopsies were performed as inpatient procedures. Positional precautions in needle aspiration lung biopsy. Since CTLBs were performed in inpatient setting at our institution, the precise rate of delayed pneumothorax could be obtained. Effect of patient positioning after needle aspiration lung biopsy. The risk of pneumothorax increases with increasing number of pleural punctures [29–31]. Funding: The authors received no specific funding for this work. Yes Accepted: Pneumothorax frequently occurred and placement of a chest tube was occasionally required for pneumothorax after CT fluoroscopy–guided lung biopsy. Timing of chest film follow-up after transthoracic needle aspiration. The intrapulmonary needle track was significantly longer in the upper lobes than in the middle/lower lobes (1.81 ± 1.56 cm vs. 1.27 ± 1.25 cm, p < 0.001) in delayed group. Seventeen patients, including 3 patients with delayed First, the study was based on single institution and population of non-immediate cases were relatively small. of an emphysematous change, biopsy guidance methods, and biopsy devices were analyzed. Terzi E, Zarogoulidis K, Kougioumtzi I, et al. To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance. Project administration, Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717–0.922 and OR = 0.610; CI = 0.441–0.844, respectively). Computed tomography; MDCT, Lesion size, location, biopsy guidance methods, Among various imaging tools including CT, fluoroscopy, and ultrasound, CT is the preferred guidance method for transthoracic lung biopsies due to its high spatial and contrast resolution [4–6]. Our study has several limitations. Abbreviations: Odds ratios (ORs) with 95% CIs were calculated. Delayed pneumothorax is clinically important because of its considerable incidence 184 Management options Where a pneumothorax is detected following a biopsy procedure, the management options include observation, aspiration, or drain insertion. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0238107. DISCUSSION. Among the 458 patients included in this study, 280 fluoroscopic-guided, 21 CT-guided, The rates of chest tube insertion between immediate and delayed pneumothorax were compared. Immediate pneumothorax was associated with smaller lesions (p < 0.001), middle/lower lobe location (p < 0.001), longer intrapulmonary needle track (p = 0.01), and emphysema (p = 0.007), compared to the group without pneumothorax. Procedures were performed under the guidance of 16-slice MDCT scanner (LightSpeed 16, GE Healthcare). Pneumothorax was considered to be “immediate” if it was detected during the procedure or in immediate post-biopsy chest CT scan. The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of late development of pneumothorax and higher requirement for chest tube drainage. and the necessity for pigtail catheterization or chest tube insertion in these patients. We sought to evaluate whether an ICT could replace the routine follow-up chest X-ray (CXR) in detecting procedure … Percutaneous transthoracic needle biopsy. However, the diagnostic yield of this practice has not been studied broadly. Percutaneous transthoracic needle aspiration: a review. Levy et al hypothesized that TBB 15. Traill ZC, Gleeson FV. Transbronchial lung biopsy and pneumothorax. Thus reduce the rate of pneumothorax requiring drainage catheter placement.

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