Most operators perform at least two biopsies but more can be obta

Most operators perform at least two biopsies but more can be obtained based on the lesion characteristic. It is important when using coaxial technique to leave always the inner stylet inside the entry needle as if the tip was in a small branch of a pulmonary vein, it may cause devastating air embolism [32]. In our institution, the standard practice is to seal the biopsy needle track with CX5461 a hydrogel plug when removing the introducer needle to prevent the air leaks and pneumothorax [33]. As

per manufacturer’s instructions, the introducer needle tip is positioned at deeper level to the visceral pleura. A hydrogel plug is advanced into the introducer needle which is then

removed, leaving the plug behind at the predetermined depth to expand upon contact with moist tissue and fill the track. The seal is airtight. The hydrogel plug resorbs into the body over time. After the biopsy is complete, a short CT scan is performed to evaluate patients for immediate complications. If the scan is normal with no significant pneumothorax and the patient is asymptomatic, the patient is transported on a gurney to the designated area for monitoring by the assigned medical staff. The patient should remain recumbent throughout the monitoring period. Follow-up expiratory chest selleck radiographs are obtained with sitting upright at 1–2 h after biopsy. If the chest radiograph shows no new changes, the patient is discharged. Upon discharge, the patient is asked to abstain from strenuous or weight-bearing activities for 3 days. Additionally, anticoagulants, antiplatelets and non-steroidal anti-inflammatory drugs are not allowed. Percutaneous transthoracic core biopsy of the lung is generally associated with higher complication rates compared to solid organ biopsy. Based on published guidelines by

the Society of Interventional Radiology, the overall complication rate of percutaneous transthoracic lung biopsies of 10% with threshold success rate of 85% are acceptable [34]. Most complications occur immediately or within the first hour of a biopsy and they can be treated conservatively; often on an outpatient basis [35], [36] and [37]. Fludarabine Common complications include pneumothorax and hemorrhage. Rare complications include air embolism, vasovagal reaction, cardiac tamponade, and seeding of the tract with tumor. Pneumothorax after CT-guided percutaneous lung biopsy has been reported from 8 to 54%, with an average of around 20% in most large series as CT imaging can detect even very small pneumothorax that may not even be visible on chest radiograph. However, the rate for pneumothoraces requiring treatment with chest tube varies from 5 to 18% [10], [35], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46] and [47].

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