Complications of percutaneous chest biopsy

Abstract

Percutaneous lung biopsy is one of the most common procedures performed in radiology departments and the minimally invasive gold standard for the histopathologic investigation of lung masses. Compared with other percutaneous biopsy procedures, lung biopsy carries a higher risk of potential complications, including occasional reports of death. Radiologists should be able to quickly recognize complications, provide required acute care, manage the patient to complete resolution, and obtain a consultation from colleagues in surgery and medicine when indicated. To this end, standing protocols for the performance of lung biopsy and the management of complications such as pneumothorax should be in place prior to performing percutaneous lung biopsy.

Keywords: Lung biopsy; chest tube; complications; pneumothorax.

Figures

Figure 1

Development of a tension pneumothorax following chest tube obstruction. (A) Chest radiograph following percutaneous biopsy shows a moderate apical pneumothorax. (B) Follow-up fluoroscopic image following placement of a Turner pigtail catheter (Cook, Bloomington, IN) and reexpansion of the lung. (C) Follow-up radiograph after the patient complained of chest tightness showing a tension pneumothorax. The chest tube was cleared, repositioned, and eventually removed following resolution of the pneumothorax.

Figure 2

Bronchoscopic biopsy leading to pneumothorax and inadvertent placement of chest vent into lung tumor without imaging guidance. (A) CT showing large, persistent pneumothorax and the tip of the chest vent tubing terminating within the mass. The chest vent was placed by the pulmonology service in the intensive care unit without the benefit of imaging guidance. (B) The patient was referred to interventional radiology for “chest tube repositioning.” Fluoroscopy shows the existing vent tubing terminating in the center of the mass. A needle has been advanced for placement of a Turner pigtail catheter. (C) Fluoroscopy shows successful placement of a Turner pigtail catheter, removal of the chest vent, and reexpansion of the lung.

Figure 3

The Turner kit for treatment of pneumothorax. A 6.3-French pigtail catheter with accompanying sharp stylet can be assembled and advanced into the pleural space under fluoroscopic or CT guidance. The accompanying tubing and one-way Heimlich valve can be assembled and attached.

Figure 4

Pulmonary hemorrhage after percutaneous lung biopsy. A 65-year-old woman with new 1 cm nodule in the left lung. (A) CT showing advancement of an introducer to a point just abutting the nodule. The patient experienced hemoptysis immediately after a core specimen was obtained. (B) Pulmonary hemorrhage after obtaining a single core biopsy specimen. The hemoptysis resolved, stability was verified by radiography, and the patient was discharged home the same day.

Figure 5

Inadvertent advancement of an introducer needle into the wall of the aorta with pericardial hemorrhage and aortic dissection. (A) CT showing 2.5-cm nodule in the right upper lobe. (B) During needle advancement, the patient reportedly experienced a violent episode of coughing and sat up on the CT table. A CT scan obtained immediately after this episode showed inadvertent placement of the needle tip in the aortic wall. (C) Within 2 minutes, the patient experienced shortness of breath and oxygen desaturation, and a repeat scan showed extravasation into the pericardial space. (D) The patient expired after resuscitative efforts. Postmortem scan showed dissection of blood into the wall of the ascending aorta and complete effacement of the aortic lumen as evidenced by inward displacement of intimal calcifications.