SIR 2024
General IR
Daniel Koh, BA
Medical Student
Boston University School of Medicine
Disclosure information not submitted.
Curtis HonShideler, MD (he/him/his)
Resident
Boston University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Suvranu Ganguli, MD (he/him/his)
Chief, Interventional Radiology
Boston Medical Center/Boston University School of Medicine
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This educational exhibit aims to review common post-operative complications following CT guided transthoracic lung biopsies and techniques to reduce the incidence of these complications. An interventional radiologist (IR) can utilize the outlined techniques and maneuvers to minimize post-lung biopsy complications and optimize outcomes.
Background:
Percutaneous lung lesion biopsy (PLLB) involves using image guidance, most commonly thoracic CT, and a percutaneous needle to aspirate or biopsy a lung lesion {1}. While PLLB is a common procedure, it has high rates of complications when compared to other IR procedures {2}. The most frequent complication is pneumothorax, with reported rates of 17 to 26.6%, followed by pulmonary hemorrhage and air embolism {3}. A variety of post-biopsy maneuvers and techniques have been developed to minimize the incidence of these complications.
Clinical Findings/Procedure Details:
Reduction in the incidence of pneumothorax and chest drain insertions has been demonstrated with the use of the rapid rollover maneuver, saline tract sealant, and deep expiration with breath holding during needle extraction. The saline tract sealant has been found to be the most effective technique in meta-analyses, reducing overall pneumothorax risk by fivefold and chest tube insertion rates by tenfold {4}. With regard to pulmonary hemorrhage, careful preprocedural planning (needle trajectory, holding anticoagulation) is the most important approach to minimizing complications. However, it is also important that patients be placed biopsy side down to prevent blood from leaking from the bronchi into the lung parenchyma {1}. Finally, while air embolism is exceedingly rare, if it does occur the patient should be started on supplemental oxygen and placed in the left lateral decubitus position.
Conclusion and/or Teaching Points:
Pneumothorax, pulmonary hemorrhage, and air embolism are complications that can occur following PLLB. Rollover maneuvers, saline tract sealant, and optimal patient positioning (biopsy side down) are techniques that have been demonstrated to minimize post-lung biopsy complications.