PURPOSE: A significant proportion of patients who undergo computed tomography (CT)-guided needle lung biopsy develop pneumothorax. Patients are typically kept at the health care facility for 3-6 hours post procedure to obtain a chest X-ray (CXR) to look for possible delayed pneumothorax. One prior study concluded that if patients have no evidence of pneumothorax immediately after CT-fine needle aspiration by CT scan then a delayed CXR adds little to the care of these patients. We reviewed patients undergoing CT-guided (core) needle lung biopsy with a negative immediate post-procedure chest CT to determine the need for delayed CXR.
METHODS: We retrospectively reviewed 75 cases of CT-guided lung biopsy (Temno® Coaxial Biopsy System, Cardinal Health, Dublin, Ohio) with a negative immediate post-procedure chest CT; all procedures were done at our VA Medical Center between 2004 and 2009. Patients underwent delayed CXR following the procedure
RESULTS: Patients’ average age was 68.2 years (SD 10.6), 74 of them were males. The lung lesions averaged 4.6 cm (SD 2.4 cm) in largest diameter and 0.25 cm (SD 0.6 cm) distance from the pleura, the average number of biopsies was 4.8 (SD 2.0) and the average time before delayed CXR was 4.2 hours. Among our 75 patients, only one patient (1.3%) had a pneumothorax on the delayed chest x-ray. The pneumothorax was small (10%) and required no treatment.
CONCLUSIONS: For patients undergoing CT-guided needle lung biopsy; if immediate chest CT after procedure shows no evidence of pneumothorax, we believe it is safe to discharge patients earlier without obtaining delayed CXR. This will save patients time and unnecessary costs
CLINICAL IMPLICATIONS: The results of our study would suggest that in selected patients undergoing CT- guided needle lung biopsy, the post procedure observation time might be safely shortened or could obviate the need for delayed post procedure chest X-ray
DISCLOSURE: The following authors have nothing to disclose: Essam Mekhaiel, Nancy Munn, Shadi Obeidat, Shadi Badin, Gress Todd
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