Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax

Appel, Elisabeth; Dommaraju, Sujithraj; Camacho, Andrés; Nakhaei, Masoud; Siewert, Bettina; Ahmed, Muneeb; Brook, Alexander; Brook, Olga R.

doi:10.1007/s00330-020-07025-y

Cited by 14 publications

(15 citation statements)

References 35 publications

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“…They found that patients in positions with the lesion below the trachea had a low incidence of pneumothorax but not of pulmonary haemorrhage or haemoptysis. 25,26 This result was consistent with another study that reported a low incidence of pneumothorax when patients were placed in the puncture-side down position rather than a supine or prone position 27 ; however, Leger et al did not observe a decrease in the pneumothorax rate in patients with the puncture-side down. 28 In addition, the puncture-side down position can be uncomfortable, inappropriate, or difficult to maintain for an extended time period for a postoperative patient.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

Zhou

Luo²,

Gu³

et al. 2022

Clinical Radiology

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Section: Discussionsupporting

confidence: 87%

“…Many strategies have been reported to reduce or prevent the development of these complications. 25,26 A type of postoperative intervention used to prevent complications involves manipulating the position of patients during and after the biopsy. Appel et al reported a retrospective study with patients who received CT-guided lung biopsy.…”

Section: Discussionmentioning

confidence: 99%

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

Zhou

Luo²,

Gu³

et al. 2022

Clinical Radiology

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

Zeng

Liao

Ren

et al. 2021

IJGM

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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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“…We suggest placing the patient in a lateral decubitus position (►Fig. 4), if tolerable by the patient, with the biopsy side down to decrease motion of the dependent lung and thus decrease the risk of pneumothorax, [18][19][20][21][22] and the operator working from either the front or the back. Another advantage of positioning the patient with biopsy side in the dependent position is decreased spillage of blood to the contralateral lung, if pulmonary hemorrhage occurs.…”

Section: Patient Selectionmentioning

confidence: 99%

Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications

Larocque

Brook

2022

Semin intervent Radiol

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Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications.

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Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax

Cited by 14 publications

References 35 publications

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

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

Lung, Pleural, and Mediastinal Biopsies: From Preprocedural Assessment to Technique and Management of Complications

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