Transthoracic ultrasound can safely rule-out pneumothorax post-lung biopsy

Abstract

Introduction: Current guidelines require a chest x-ray 1 hour post transcutaneous imaging-guided lung biopsy, in order to rule-out pneumothorax. This delays patient discharge, leads to longer waiting times and more radiation. Thoracic ultrasound (TUSS) is proven to be a safe and fast tool that has very high specificity in ruling-out pneumothorax, when performed by trained chest physicians. Objective: To assess the efficacy and safety of a TUSS-only protocol to rule-out post biopsy pneumothorax. Methods: 48 patients had US-guided biopsy (USGB) for peripheral lung/mediastinal lesions. Mean age 66.8 (SD± 12.0), mean FEV1 (Lts) was 1.61 (SD± 0.55), mean tumour size was 38.3mm (SD± 27.0) and mean distance from skin was 14.2mm (SD± 9.0). Tumours were located in lower lobes in 45.8% and in upper lobes in 54.2%. A bilateral 6-point TUSS (2D and M-mode) was performed before the biopsy as a baseline. Another 6-point TUSS was performed 10 minutes and 30 minutes post USGB, establishing presence of “sliding” and “seashore” signs. All patients were discharged home 30 minutes post biopsy and followed up with a phonecall later the same day. Results: Both “sliding” and “seashore” signs were present post USGB in 46/48 patients (95.8%). In 2 patients there was no clear “sliding” but there was “seashore” sign post biopsy. None of the patients reported shortness of breath or haemoptysis. One patient reported new pleuritic pain, had a repeat TUSS and chest x-ray and confirmed to have a small subcutaneous haematoma. Conclusions: TUSS performed by trained chest physicians can safely rule-out pneumothorax post USGB.