Intervention in patients with pneumothorax immediately following CT-guidedfine needle aspiration of pulmonary nodules.
Ryland P Byrd, Anand B Karnad, Mathew G Mathai, Harsha N Shantaveerappa, Jayant B Mehta, Thomas M Roy
Med Sci Monit 2002; 8(6): CR401-404
BACKGROUND: The incidence of pneumothorax (PTX) as a complication of computerizedtomography guided fine needle aspirates (CT-FNA) of solitary pulmonary nodules (SPN) varies from 8-61%.It has been suggested that the practice of obtaining a delayed chest radiograph in patients who haveundergone CT-FNA of SPN is not cost effective and adds little information concerning lung expansion obtainedby CT at the end of the procedure. It, however, is not known what percent of patients with a PTX presentimmediately after CT-FNA but do not require prompt chest tube placement will progress and require interventionlater.MATERIAL/METHODS: One hundred-fifty-eight consecutive patients undergoing CT-FNA of SPN were includedin the study. Immediately after CT-FNA each patient was reimaged with the CT scanner to check for PTX.Patients with a PTX immediately after CT-FNA were assessed as to whether intervention was undertakenor whether the PTX enlarged and/or required drainage at a later time.RESULTS: Thirty-eight patients developeda PTX while still on the CT scanner. Twenty-nine patients with an immediate PTX did not require drainageof their pleural space. Chest tube placement was required promptly after the CT-FNA in 4 patients. Fivepatients had their pleural space drained at a later time due to an increasing size of the PTX and/orthe development of symptoms attributed to the PTX.CONCLUSIONS: These data suggest that patients who developa PTX immediately after CT-FNA but who do not require prompt pleural space evacuation should be followedclosely both clinically and radiographically.
Keywords: Biopsy, Needle, Lung Diseases, Pneumothorax, Tomography, X-Ray Computed