Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

Abstract

Intercostal artery injury during transthoracic puncture is rare but is accompanied by high rates of morbidity and mortality. We report a case with metachronous double primary esophageal cancers and development of multiple lung nodules. Tissue proof for the lung nodules is required to guide the following treatment protocol. Our patient died soon after computed tomography‐guided lung tumor biopsy was performed, as a result of procedure‐related massive and uncontrolled hemothorax. The cause is likely intercostal artery injury related to the transthoracic puncture. After review of our case and the wide variation in intercostal artery courses, we identify several considerations that should be included in procedural planning to further decrease the risk of intercostal artery injury during transthoracic puncture, including avoiding choosing target lesions at the posterior lung, keeping the puncture needle as close to the superior rib margin as possible, and checking the density of new pleural fluid. In addition, it is important to inform clinical doctors when the risk of periprocedural vascular injury is high.

Multiplanar reconstruction technique for difficult computed tomography‐guided lung biopsy: Improved accuracy and safety

“…Although severe complications of CT‐guided lung biopsy are rare, they can be fatal. Rapid hemothorax with hemodynamic change is a severe complication, and death can occur if the complication is not detected and managed early . Hemothorax is often caused by injury to the intercostal artery or internal mammary artery.…”

“…Rapid hemothorax with hemodynamic change is a severe complication, and death can occur if the complication is not detected and managed early. 5 Hemothorax is often caused by injury to the intercostal artery or internal mammary artery. The intercostal artery is shielded in the intercostal groove of the superior rib, but there is variability to the arterial course (Fig.…”

“…The most common complication of CT‐guided lung biopsy is pneumothorax, followed by pulmonary hemorrhage . Hemothorax is rare, but sometimes causes rapid hemodynamic change and death . Avoiding puncture of systemic arteries, such as the subclavian, axillary, internal mammary, and intercostal arteries can limit this complication .…”

“…3,4 Hemothorax is rare, but sometimes causes rapid hemodynamic change and death. 5 Avoiding puncture of systemic arteries, such as the subclavian, axillary, internal mammary, and intercostal arteries can limit this complication. [3][4][5] Use of the axial CT view alone can be ambiguous or less accurate to safely confirm the biopsy.…”