[Ultrasound-guided transthoracic puncture]

Abstract

The diagnosis of peripheral lung foci may prove difficult. In addition to transthoracic puncture under X-ray fluoroscopy or CT control, ultrasound-guided puncture was shown to be a useful alternative. A prerequisite, however, is that the lesion should extend up to the pleura. This overview covers 97 original papers, of which 26 mainly consisted of lung punctures in a total of 1876 patients. The accuracy in carcinomas and metastases was 70 to 97%, on average markedly higher than 90%. Benign lesions are histologically more difficult to distinguish; here the accuracy is 70%. Partly due to pre-selection the method has a very low rate of complications. The rate of pneumothorax is 2.6%, those requiring drainage are about 1%. Haemoptyses occur 1-2% of the punctures, most commonly in cases of chronic pneumonia; colour-coded Duplex sonography is especially recommended in these cases because of the strong and regular vascularisation. The rate of complication increases in direct proportion to needle thickness. The possibilities of ultrasound-guided lung abscess drainage are also discussed. An intrathoracic lesion that is accessible to ultrasound imaging should be punctured today under ultrasound guidance, as this procedure is minimally stressful for the patient, is accurate, has a low rate of complications and is also cost effective.