Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence

Bae, Kyungsoo; Ha, Ji Young; Jeon, Kyung Nyeo

doi:10.1371/journal.pone.0238107

“…According to previous studies, 8–10 lower lobe location is regarded as a risk factor for pneumothorax compared to the upper and middle lobe location, mainly due to greater respiratory motion of the lower lobe. However, investigators have reported delayed pneumothorax more frequently occurring in upper lobes, 11–13 which was not consistent with previous studies in which all cases of pneumothorax were included regardless of the onset. In general, lower lobe location with great movement may lead to the early appearance of pneumothorax, and upper lobe location with less movement may result in the late appearance of pneumothorax.…”

Section: Factors Influencing the Pneumothorax Formationmentioning

confidence: 65%

“… 13 Delayed pneumothorax showed higher requirement of chest tube insertion compared to immediate pneumothorax, ranging from 7.1% to 29.6% of the overall rate of pneumothorax. 11 Therefore, the treatment of this condition is clinically significant.…”

Section: Management Of Delayed Pneumothoraxmentioning

confidence: 99%

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

Zeng

¹

,

Liao

²

,

Ren

³

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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“…15,17,26 Surprisingly, there was no relationship between pneumothorax and emphysema of the underlying lung, in contrast to reports. 11,13,15,27 The only explanation for this could be the limited number of patients with emphysema in this study, which may have obscured the expected increased risk of pneumothorax. An increased overall pulmonary hemorrhage was observed with underlying emphysema.…”

Section: Discussionmentioning

confidence: 88%

Molecular characterization of carbapenem-resistant Enterobacterales in thirteen tertiary care hospitals in Saudi Arabia

Al-Abdely

¹

,

Alhababi

²

,

Dada

³

et al. 2021

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BACKGROUND: Carbapenems are the antibiotics of last-resort for the treatment of bacterial infections caused by multidrug-resistant organisms. The emergence of resistance is a critical and worrisome problem for clinicians and patients. Carbapenem-resistant Enterobacterales (CRE) are spreading globally, are associated with an increased frequency of reported outbreaks in many regions, and are becoming endemic in many others. OBJECTIVES: Determine the molecular epidemiology of CRE isolates from various regions of Saudi Arabia to identify the genes encoding resistance and their clones for a better understanding of the epidemio-logical origin and national spread. DESIGN: Multicenter, cross-sectional, laboratory-based study. SETTING: Samples were collected from 13 Ministry of Health tertiary-care hospitals from five different regions of Saudi Arabia. METHODS: Isolates were tested using the GeneXpert molecular platform to classify CRE. MAIN OUTCOME MEASURES: Prevalence of various types of CRE in Saudi Arabia. SAMPLE SIZE: 519 carbapenem-resistant isolates. RESULT: Of 519 isolates, 440 (84.7%) were positive for CRE, with Klebsiella pneumoniae (410/456, 90%) being the most commonly isolated pathogen. The distribution of the CRE-positive K pneumoniae resistance genes was as follows: OXA-48 (n=292, 71.2%), NDM-1 (n=85, 20.7%), and NDM+OXA-48 (n=33, 8%). The highest percentage of a single blaOXA-48 gene was detected in the central and eastern regions (77%), while the bla NDM -gene was the predominant type in the northern region (27%). The southern regions showed the lowest percentages for harboring both blaOXA-48 and bla NDM genes (4%), while the western region isolates showed the highest percentage of harboring both genes (14%). CONCLUSION: The results illustrate the importance of molecular characterization of CRE isolates for patient care and infection prevention and control. Larger multicenter studies are needed to critically evaluate the risk factors and trends over time to understand the dynamics of spread and effective methods of control. LIMITATIONS: Lack of phenotypic susceptibility and clinical data. CONFLICT OF INTEREST: None.

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“… 13 In our case, pneumothorax, which actually existed, could not be detected by CXR and may have caused the diagnosis to be delayed, or as in some of the reported cases, a delayed pneumothorax occurred. 13 , 16 …”

Section: Discussionmentioning

confidence: 49%

“…1 t test, 2 Fischer's exact test, 3 Man-Whitney U test, 4 Pearson's chi square test, 5 Continuity-corrected chi-square test The rate of pneumothorax varied in previous studies from between 12-45% and 2-15% of cases required a chest tube replacement. 9,[13][14][15] In our study, a 22% rate of pneumothorax with a 5.7% rate of chest tube replacement was identified. In previous studies, factors increasing the risk of pneumothorax included a smaller lesion size, underlying emphysema, an increased depth of lesion, multiple pleural passes, and fissure punctures.…”

Section: Discussionmentioning

confidence: 58%

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies

Yücel

¹

,

Sayit

²

,

Tomak

³

et al. 2021

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BACKGROUND: Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them. OBJECTIVES: Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB). DESIGN: Prospective evaluation of complications. SETTING: Single center in Turkey. PATIENTS AND METHODS: For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology. MAIN OUTCOME MEASURES: The complications and risk factors for complications were evaluated. SAMPLE SIZE: 123 adult patients. RESULTS: The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema ( P =.022), non-peripheral location of the lesion ( P <.001), increased needle pathway ( P <.001), fissure penetration ( P =.011), increased number of pleura penetrations ( P =.024), prolonged needle time across pleura ( P =.037), and decreased lesion size ( P =.033). The pneumothorax rate increased with non-peripheral location of the lesion ( P <.007), fissure penetration ( P =.021), prolonged needle time across the pleura (P=.013), and decreased lesion size ( P =.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion ( P <.001, OR=14.7, 95% CI=3.9–55.4 for alveolar hemorrhage) and ( P =.001, OR=156.2, 95% CI =7.34–3324.7 for pneumothorax). CONCLUSION: Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications. LIMITATIONS: Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding. CONFLICT OF INTEREST: None.

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Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence

Cited by 16 publications

References 33 publications

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

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

Molecular characterization of carbapenem-resistant Enterobacterales in thirteen tertiary care hospitals in Saudi Arabia

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies

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