IMMEDIATE MANUAL ASPIRATION OF PROBLEMATICAL PNEUMOTHORAX AFTER CT GUIDED LUNG BIOPSY CAN INCREASE THE POSSIBILTY OF AVOIDING TREATMENT USING A CHEST TUBE
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Purpose: To evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and to avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy. Patients and Methods: This prospective study was based on experience from 180 consecutive percutaneous needle lung biopsies. While still on the scanner table, patients with complicated pneumothorax on post-biopsy chest CT images underwent percutaneous manual aspiration with an 18 or 20-G i.v. catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. Results: Post-biopsy pneumothorax occurred in 59 of 180(32.77%) procedures. Manual aspirations in 31 of these 59 patients were carried out after biopsy (52.54%). The pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement in 50 of the 59 pneumothoraces (84.74%). Only 5 patients (8.47% of the entire series who developed pneumothorax) required chest tube placement from the start. The mean time from biopsy until resolution of the pneumothorax for these 5 patients was 7.0 ± 7.0 days. In particular, time until recovery was diminutive both in those 23 cases (38.98%) not requiring manual aspiration (2.5 ± 2.0 days) and in those 31cases (52.54%) with a pneumothorax that disappeared completely or almost completely after manual aspiration (2.0 ± 1.5 days). However 4 patients (6.77% of the entire series who developed pneumothorax) of the last group were subjected for chest tube insertion after increasing size of pneumothorax. Conclusion: Requirement of chest tube insertion significantly increased in parallel with the increased volume of pneumothorax. The almost equally short recovery periods in patients not requiring manual aspiration and those patients requiring immediate manual aspiration indicates the value of rapid management to eliminate the need for chest tube placement.