From the Guidelines
Iatrogenic pneumothorax post CT-guided biopsy in the UK should be managed with initial aspiration, followed by drainage if a leak and significant pneumothorax persist, as recommended by the BTS guidelines 1. The management of iatrogenic pneumothorax following CT-guided biopsy in the UK is guided by factors such as the size of pneumothorax, co-existent lung pathology, and pain suffered.
- The size of the pneumothorax is a crucial factor in determining the management approach, with smaller pneumothoraces potentially being managed with observation and larger ones requiring intervention.
- Co-existent lung pathology, such as emphysema, can affect respiratory reserve and influence the management decision.
- Pain suffered by the patient is also an important consideration in determining the need for intervention. According to the BTS guidelines, initial treatment by aspiration is recommended, with subsequent drainage if a leak and significant pneumothorax persist 1.
- A small gauge drain is usually adequate for drainage, and chest drains are required in 3.3–15% of all patients undergoing lung biopsy.
- In the UK, most clinicians attach drains to an underwater seal, but the Heimlich one-way flutter valve is an alternative, allowing for prolonged drainage and outpatient management. The Heimlich valve can be replaced by a system attached to an underwater seal if the pneumothorax continues to enlarge or the patient develops surgical emphysema 1.
- The management approach should prioritize minimizing morbidity, mortality, and improving quality of life, and the BTS guidelines provide a framework for clinicians to make informed decisions about the management of iatrogenic pneumothorax post CT-guided biopsy in the UK.
From the Research
Management of Iatrogenic Pneumothorax Post CT-Guided Biopsy in the UK
- The management of iatrogenic pneumothorax post CT-guided biopsy involves observation, manual aspiration, and chest tube placement 2, 3, 4.
- The majority of pneumothoraces are benign and do not require any intervention, just observation 2.
- Manual aspiration is an effective way of treating moderate pneumothoraces with a success rate of 90%, thereby reducing the number of cases requiring catheter insertion 2, 3, 4.
- The amount of aspirated air can be predictive of the requirement for chest tube placement 3.
- Chest tube placement is an important treatment strategy for patients with a large or symptomatic pneumothorax 5, 6.
Factors Influencing the Incidence of Pneumothorax
- The risk of pneumothorax significantly increases with lesion size and depth 4.
- The presence of emphysema, the number of pleural surfaces and fissure crossed, and other factors can also influence the incidence of pneumothorax 6.
Treatment Options
- Observation and oxygen treatment are available for small, asymptomatic pneumothoraces 6.
- Simple manual aspiration can be used to treat moderate pneumothoraces 2, 3, 4.
- Chest tube placement is necessary for large or symptomatic pneumothoraces 5, 6.
- Biopsy side down positioning of the patient after biopsy can significantly reduce the incidence of pneumothorax and the requirement of chest tube placement 6.