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Original Research: Pulmonary Procedures |

Ipsilateral Opposite-Side Aspiration in Resistant Pneumothorax After CT Image Guided Lung BiopsyIpsilateral Opposite-Side Aspiration: Complementary Role After Simple Needle Aspiration

Daniel Yaffe, MD; David Shitrit, MD; Maya Gottfried, MD; Gabriel Bartal, MD; Jacob Sosna, MD
Author and Funding Information

From the Departments of Radiology (Drs Yaffe and Bartal), Pulmonary Medicine (Dr Shitrit), and Oncology (Dr Gottfried), Meir Medical Center, Kfar Saba, Israel; Department of Radiology (Dr Sosna), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and the Department of Radiology (Dr Sosna), Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA.

Correspondence to: David Shitrit, MD, Department of Pulmonary Medicine, Meir Medical Center, Kfar Saba, 44281, Israel; e-mail: davids3@clalit.org.il


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):947-951. doi:10.1378/chest.12-2790
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Background:  The goal of this study was to evaluate the efficacy of ipsilateral opposite-side aspiration, a new method to overcome resistant pneumothorax after failure of a simple aspiration. The patient position is reversed (from prone to supine or vice versa) and the aspiration repeated.

Methods:  Between January 1, 2010, and April 3, 2012, 129 consecutive, CT image-guided, percutaneous needle biopsies of lung nodules were performed in 127 patients (75 men, 52 women; mean age, 67.8 years; range, 26-88 years). Two patients underwent repeated biopsies. The mean lesion diameter was 38 mm (range, 8-110 mm). Core biopsy and fine-needle aspiration (FNA) were performed in 126 procedures; in three cases, only FNA was performed. In the cases with symptomatic minimal pneumothorax and in all patients with pneumothorax > 10 mm, immediate, simple, manual aspiration was performed. Ipsilateral opposite-side aspiration was performed when simple aspiration failed.

Results:  Among 129 CT image-guided biopsies, pneumothorax was detected by CT scan in 54 (42%); 51 (39%) were detected during the biopsy. Delayed pneumothorax occurred in two patients (1.55%). Manual aspiration to treat pneumothorax was performed in 27 of 129 procedures (21%). Simple aspiration was successful in 20 of these 27 cases (74%). Ipsilateral opposite-side aspiration was accomplished in the remaining seven cases (26%) and was successful in six cases (86%). Two of 129 procedures (1.55%) required chest tube placement.

Conclusions:  Immediate, simple, percutaneous aspiration of iatrogenic pneumothorax was successful in 74% of patients needing treatment. Our proposed new method of ipsilateral opposite-side aspiration offers a solution for patients who remain with resistant pneumothorax after simple aspiration.

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