Metallic Weakness and Breakage of Abrams Pleural Biopsy Needle

Abstract

To the Editor:We read with interest the recent report by Fité et al of one case of pleural effusion in which breakage and detachment in the pleural cavity of the tip of a nearly new Abrams needle occurred during performance of a pleural biopsy.1Fité E Force L Casarramona F Verdaguer A. Breakage and detachment of an Abrams needle in the pleural cavity during performance of a pleural biopsy.Chest. 1989; 95: 928-929Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Recently, we cared for a 60-year-old man hospitalized for investigation of left pleural effusion. Chest ultrasound showed loculated pleural effusion and thickening of the parietal pleura. Thoracentesis revealed bloody effusion, samples of which showed predominance of lymphocytes and numerous red blood cells negative for malignancy. Tuberculous bacillus was not found in acid-fast stain. The study of pleural effusion was inconclusive. A pleural biopsy was done by means of an Abrams needle. When the needle was withdrawn, the tip was missing from the midportion of the window through which we took the biopsy sample (Fig 1). A chest x-ray film showed the tip of the Abrams needle lodged in the left posterior pleural cavity. Computed tomography of the chest showed pleural thickening, pulmonary consolidation, and a metallic tip within the pleural cavity (Fig 2). After four months of observation, the intrapleural foreign body has not caused any complications. A culture of pleural effusion grew Mycobacterium tuberculosis organisms six weeks later. Antituberculosis therapy has been started.FIGURE 2Computed tomographic scan of the thorax showing thickening of the pleura, loculated pleural effusion, pulmonary consolidation, and the intrapleural metallic body (arrow).View Large Image Figure ViewerDownload (PPT)We believe that the accident reported above, resulting from detachment of the trocar tip in the pleural cavity, may be attributed to metallic failure at the window through which the biopsy is performed. Another Abrams needle used for approximately the same number of patients (approximately 40) showed angularity and evidence of breakage at the midportion of the window (Fig 1). This needle is not used for pleural biopsy any more. However, we agree with the opinion of Fité et al that such accidents could be prevented by manufacturing a one-piece trocar and reinforcing at the midportion of the window. Also, the durability of the Abrams pleural biopsy needle (ie, how many patients or how many years for a new needle could be used) should be determined. To the Editor: We read with interest the recent report by Fité et al of one case of pleural effusion in which breakage and detachment in the pleural cavity of the tip of a nearly new Abrams needle occurred during performance of a pleural biopsy.1Fité E Force L Casarramona F Verdaguer A. Breakage and detachment of an Abrams needle in the pleural cavity during performance of a pleural biopsy.Chest. 1989; 95: 928-929Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Recently, we cared for a 60-year-old man hospitalized for investigation of left pleural effusion. Chest ultrasound showed loculated pleural effusion and thickening of the parietal pleura. Thoracentesis revealed bloody effusion, samples of which showed predominance of lymphocytes and numerous red blood cells negative for malignancy. Tuberculous bacillus was not found in acid-fast stain. The study of pleural effusion was inconclusive. A pleural biopsy was done by means of an Abrams needle. When the needle was withdrawn, the tip was missing from the midportion of the window through which we took the biopsy sample (Fig 1). A chest x-ray film showed the tip of the Abrams needle lodged in the left posterior pleural cavity. Computed tomography of the chest showed pleural thickening, pulmonary consolidation, and a metallic tip within the pleural cavity (Fig 2). After four months of observation, the intrapleural foreign body has not caused any complications. A culture of pleural effusion grew Mycobacterium tuberculosis organisms six weeks later. Antituberculosis therapy has been started. We believe that the accident reported above, resulting from detachment of the trocar tip in the pleural cavity, may be attributed to metallic failure at the window through which the biopsy is performed. Another Abrams needle used for approximately the same number of patients (approximately 40) showed angularity and evidence of breakage at the midportion of the window (Fig 1). This needle is not used for pleural biopsy any more. However, we agree with the opinion of Fité et al that such accidents could be prevented by manufacturing a one-piece trocar and reinforcing at the midportion of the window. Also, the durability of the Abrams pleural biopsy needle (ie, how many patients or how many years for a new needle could be used) should be determined.