Pneumothorax and pulmonary hemorrhage after C-arm cone-beam computed tomography-guided percutaneous transthoracic lung biopsy: incidence, clinical significance, and correlation

Abstract

Objective: This study aimed to assess the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after percutaneous transthoracic lung biopsy (PTLB) guided by C-arm cone-beam computed tomography (CBCT). Furthermore, this study aimed to examine the relationships between PTX and PH with demographics, clinical characteristics, imaging, and PTLB parameters.

Methods: A retrospective analysis was conducted on 192 patients who underwent PTLB at our hospital between January 2019 and October 2022. Incidences of PTX and PH were recorded. PTX was considered clinically significant if treated with chest tube insertion (CTI), and PH if treated with bronchoscopes or endovascular treatments. The various factors on PTX and PH were analyzed using the Chi-squared test and Student t-test. Logistic regression analyses were then used to determine these factors on the correlation to develop PTX and PH.

Results: PTX occurred in 67/192 cases (34.9%); CTI was required in 5/67 (7.5%). PH occurred in 63/192 cases (32.8%) and none of these cases required bronchoscopes or endovascular treatments. Lesion diameter (OR_PTX = 0.822; OR_PH = 0.785), presence of pulmonary emphysema (OR_PH = 2.148), the number of samples (OR_PH = 1.834), the use of gelfoam (OR_PTX = 0.474; OR_PH = 0.341) and ablation (OR_PTX = 2.351; OR_PH = 3.443) showed statistically significant correlation to PTX and PH.

Conclusions: CBCT-guided PTLB is a safe and effective method for performing lung biopsies. The use of gelfoam has been shown to reduce the occurrence of PTX and PH. However, caution should be exercised when combining radiofrequency ablation with PTLB, as it may increase the risk of PTX and PH.

Keywords: C-arm cone-beam CT; Percutaneous transthoracic lung biopsy; Pneumothorax; Pulmonary hemorrhage.

Fig. 1

Flow chart showing the enrolled patients. PTLB percutaneous transthoracic lung biopsy, CBCT C-arm cone-beam computed tomography, pneumothorax (PTX), pulmonary hemorrhage (PH)

Fig. 2

a Pre-procedure CT: A 79-year-old man with a history of hepatectomy for hepatocellular carcinoma 2 years ago presented with a 24-mm solid pulmonary lesion in the left lower lobe. b Following the combined procedure of percutaneous transthoracic lung biopsy (PTLB) and radiofrequency ablation (RFA), the patient experienced a severe pneumothorax, which necessitated chest tube insertion (CTI). The chest tube was left in place for drainage purposes for 2 days

Fig. 3

a Pre-procedure CT: A 69-year-old man with a 29-mm solid pulmonary lesion in the left lower lobe. b On the post-procedural CT scan, a ground-glass opacity was observed in the pulmonary parenchyma. However, the patient did not experience any episodes of hemoptysis