From the Guidelines
The incidence of pneumothorax after bronchoscopy with transbronchial lung biopsy is approximately 3.5%, with about 50% of patients requiring drainage, as reported in the British Thoracic Society guidelines on diagnostic flexible bronchoscopy 1.
Incidence and Risk Factors
The incidence of pneumothorax after bronchoscopy with transbronchial lung biopsy can vary depending on several factors, including the patient's underlying lung disease and the use of mechanical ventilation.
- In patients with diffuse lung disease, the incidence of pneumothorax was reported to be 3% after transbronchial biopsy specimens were taken without fluoroscopic screening 1.
- The use of fluoroscopy did not appear to reduce the frequency of pneumothorax in these patients 1.
- In patients who are mechanically ventilated, the incidence of pneumothorax was reported to be as high as 14% 1.
Post-Procedure Monitoring and Management
Post-procedure monitoring is essential to detect pneumothorax, and many centers perform a chest X-ray 1-2 hours after the procedure to detect this complication 1.
- A chest radiograph should be carried out at least 1 hour after transbronchial biopsy to exclude a pneumothorax 1.
- Patients who have had transbronchial biopsies should be given verbal and written advice about the possibility of developing a pneumothorax after leaving hospital 1.
- The risk of pneumothorax can be minimized by limiting the number of biopsies, avoiding biopsies in patients with severe emphysema when possible, and ensuring the procedure is performed by experienced bronchoscopists.
From the Research
Incidence of Pneumothorax after Bronchoscopy with Transbronchial Lung Biopsy
- The incidence of pneumothorax (PTX) after bronchoscopy with transbronchial lung biopsy (TBB) is estimated to be around 1-6% 2, 3, 4, 5.
- A study published in 2006 found that PTX occurred in 2.9% of cases after TBB 3.
- Another study published in 2019 found that the prevalence of PTX after TBB was 3.4% 5.
- A study published in 2017 found that the incidence of PTX after TBB in patients with pulmonary fibrosis was 7.2% 6.
Risk Factors for Pneumothorax
- Patients with underlying lung disease, such as emphysema, are more prone to developing a PTX 2.
- Low immunity and poor wound healing due to chronic inflammation or steroid use can play a role in causing a delayed PTX 2.
- The use of pain drugs such as opioids is associated with iatrogenic PTX 2.
- Patients with lung malignancies, either primary or metastatic, can increase the risk of secondary PTX 2.
Diagnosis and Management of Pneumothorax
- Chest radiography (CXR) is commonly used to detect PTX after TBB, but it may not be necessary in asymptomatic patients 3, 5.
- Ultrasonography (US) has been shown to be accurate in detecting PTX after TBB and may become the method of choice for diagnosing, monitoring, and managing PTX after TBB 4.
- Asymptomatic patients with PTX may not require intervention, while symptomatic patients may require chest tube placement, inpatient admission, or observation 5.