Percutaneous Transthoracic Needle Aspiration Biopsy Research Articles

SYSTEMIC AIR EMBOLISM AFTER PERCUTANEOUS CT-GUIDED LUNG BIOPSY

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Computed-tomography (CT) guided transthoracic needle biopsy (TTNB) is widely performed to establish a histological diagnosis of peripheral lung tumors. Systemic air embolism is described as a rare complication. CASE PRESENTATION: In a 70-year-old man with systemic arterial hypertension and benign prostatic hypertrophy a peripheral pulmonary consolidation in the left upper lobe and multiple brain nodules were detected after an acute episode of epilepsy. As a primary lung tumor was suspected, he underwent a total body positron emission tomography-CT scan, showing pathological glucose uptake in the left lung lesion (Figure 1) and metastatic involvement of mediastinal lymph nodes, adrenal glands and vertebral bodies. His coagulation profile, hemoglobin and platelets levels were normal, so a bronchoscopy with transbronchial lung biopsy under fluoroscopy was set. The histological analysis showed bronchial inflammatory cells, so the patient underwent a CT-guided TTNB. Under local anesthesia, two bioptic samples were collected using the 18-gauge outer coaxial needle by an expert interventional radiologist (Figure 2A). During the procedure the onset of air embolism in both heart ventricles, main pulmonary artery and ascending aorta was immediately detected on CT scans (Figure 2B). A layer of ipsilateral pneumothorax (maximum thickness 12 mm) together with chest wall subcutaneous emphysema were present. The patient complained about general malaise with signs of hypotension and desaturation. No electrocardiographic alterations were recorded. After he was administered 100% oxygen through a mask and hydrated, his clinical conditions rapidly improved. Two hours later a chest and brain CT scans were repeated. While cardiac, aortic and pulmonary artery air embolisms were solved, the pneumothorax layer increased (20 mm) (Figure 3). No ischemic lesions were detected in brain CT scans. The patient was maintained on close monitoring and after four days the pneumothorax was no longer radiologically detectable. An invasive lung adenocarcinoma was diagnosed and the patient was referred to the Oncology Department. DISCUSSION: Systemic air embolism is described in 0.02-0.07% of TTNB (1). Direct exposure of pulmonary vein to air through the needle, bronchovenus fistula formation and air penetration from the pulmonary arterial circulation to the pulmonary vein are all possible pathogenic mechanisms (2). Possible prevention strategies include avoiding coughing and straining during the procedure and ventilation with positive pressure (3). No specific treatment has established yet other than supplying 100% oxygen and hyperbaric chamber. The patient has to be strictly monitored because potential life-threatening complications may rise and the repetition of a chest-brain CT scan may be urgently needed (3). CONCLUSIONS: Even if uncommon, systemic air embolism after TTBN must be always considered and rapidly handled. Reference #1: Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol. 1976;17:813-28 Reference #2: Mokhlesi B, Ansaarie I et al. Coronary artery air embolism complicating CT.guided transthoracic needle biopsy of the lung. Chest. 2002;121:993-996 Reference #3: Hare SS, Gupta ATC et al. Systemic arterial air embolism after percutaneous lung biopsy. Clin Radiol. 2011;66:589-596. DISCLOSURES: No relevant relationships by Paolo Ceruti, source=Web Response No relevant relationships by SARA ALESSANDRA LONNI, source=Web Response

Cavitary Form of Lung Metastasis from Advanced Hepatocellular Carcinoma

The most common site of extrahepatic metastasis in cases of advanced hepatocellular carcinoma is the lung. A 60-year-old Korean male had been previously diagnosed with hepatocellular carcinoma and was treated several times with transcatheter arterial chemoembolization prior to a regime of sorafenib after multiple bone metastases were detected. Despite 2 months of systemic treatment, the disease progressed, and newly developed cavitary nodules and ground glass opacities were observed on a chest computed tomography scan. Initially the patient was diagnosed with septic pneumonia and was subsequently treated with antibiotics over 2 weeks, with no observable improvement. A percutaneous transthoracic needle aspiration biopsy was performed to ascertain the noninfectious origin of the lung lesions. As a result, a rare form of pulmonary metastasis from hepatocellular carcinoma was discovered. Unfortunately, there were no available treatment options for the patient and so end-of-life care was recommended. (Korean J Med 2015;88:202-206)

Computed Tomographic Fluoroscopy-Guided Needle Aspiration Biopsy as a Second Biopsy Technique After Indeterminate Transbronchial Biopsy Results for Pulmonary Lesions

The purpose of this study was to compare the diagnostic performance of computed tomographic (CT) fluoroscopy-guided percutaneous transthoracic needle aspiration biopsy (NAB) and transbronchial lung biopsy (TBLB) after indeterminate bronchoscopy in patients with suspected malignant pulmonary lesions. We included 77 patients who underwent CTF-NAB (n = 53) or TBLB (n = 24) as a second biopsy for pulmonary lesions because of inconclusive pathologic results on initial TBLB. Sensitivity, specificity, and diagnostic accuracy were calculated and compared between the 2 groups using the Fisher exact test. Sensitivity and diagnostic accuracy were also compared according to lesion depth (central vs peripheral), lesion location (upper vs lower), and lesion size (<2 vs 2-3 vs >3 cm). There were 50 (65%) malignant and 27 (35%) benign lesions. The overall sensitivity, specificity, and accuracy for diagnosing pulmonary lesions were 84%, 100%, and 91% for NAB and 50%, 100%, and 63% for TBLB. The sensitivity and accuracy for diagnosing pulmonary lesions were significantly different between the 2 groups (P = 0.019, and P = 0.008). The sensitivity and accuracy of TBLB for diagnosing lesions was significantly different according to the lesion size (P = 0.025, and P = 0.048). A second biopsy using CT fluoroscopy-guided NAB is a useful diagnostic modality for exact diagnosis of pulmonary lesions in cases of inconclusive pathologic results on initial TBLB.

MDCT-Guided Transthoracic Needle Aspiration Biopsy of the Lung Using the Transscapular Approach

The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients.

Enterococcus faecium lung abscess: one case report and literature review

to study the diagnosis and treatment of enterococcus faecium lung abscess. a retrospective analysis of one case of Enterococcus faecium lung abscess and literature review was conducted. this patient suffered from cough and sputum over 6 months and complicated with hemoptysis over 3 months. Pulmonary embolism and lung cancer were suspected initially. After 2 times of CT-guided percutaneous transthoracic needle aspiration biopsy the diagnosis of pneumonia was made in other hospitals. However, the consolidation in the lung progressed and cavity appeared although antibiotic therapy was conducted. After admission to our hospital, CT-guided percutaneous transthoracic needle aspiration biopsy was made and the lung tissue was sent for bacterial culture. Enterococcus faecium was cultured and it was susceptible to vancomycin, teicoplanin and linezolid. The disease improved significantly after treatment with these 3 antibiotics in turn. In addition, 13 cases of enterococcus pneumonia or lung abscess were reviewed, including 3 cases of enterococcus faecium lung abscess. enterococcus faecium is rarely a pathogen for lung abscess. The diagnosis of enterococcus faecium lung abscess could be confirmed by lung biopsy and bacterial culture of lung tissue which could also provide the susceptibility of antibiotics and guide the antibiotic therapy.

Percutaneous Transthoracic Needle Aspiration Biopsy: A Comprehensive Review of Its Current Role in the Diagnosis and Treatment of Lung Tumors

The purpose of this study is to examine the accuracy and complications of transthoracic needle aspiration biopsy (TTNA) to determine its optimal role in the evaluation of patients with lung tumors. The charts of 130 consecutive patients who had undergone CT-guided TTNA were reviewed retrospectively. Thirty-two (25%) of these patients had subsequent surgery and 5 had subsequent transbronchial biopsy (TBB). Using the final surgical and TBB diagnosis as a reference, the accuracy, sensitivity, specificity, and prevalence of malignancy were calculated. Each case was also examined to determine the presence or absence of complications. Of the 130 biopsy results, 95 (73%) were malignant, 33 (25%) were nonspecific, and only 2 (2%) had a specific benign diagnosis. Thirty-two patients subsequently underwent surgical resection. The overall prevalence of malignancy after surgical diagnosis was 91%. The overall diagnostic accuracy of TTNA was 76%. The sensitivity of TTNA for the detection of malignancy was 74% and its specificity was 100%. When comparing TTNA results of small (<3 cm) and large (> or = 3 cm) tumors, the occurrence of nonspecific results was 36% and 16%, respectively. Fifty-six (43%) patients had a pneumothorax subsequent to TTNA. Twenty-four (43%) of these patients required a chest tube and remained hospitalized for a mean of 6 days. Patients who are surgical candidates and have a high clinical suspicion for malignancy should undergo surgical biopsy and resection of their lung tumors if indicated. Information gained from TTNAs performed on this patient population will rarely result in a change in their clinical management.

Percutaneous transthoracic needle aspiration biopsy in diagnosis of lung cancer

Percutaneous transthoracic needle aspiration biopsy in diagnosis of lung cancer

Complications of percutaneous transthoracic needle aspiration biopsy.

After 5,300 percutaneous transthoracic needle aspiration biopsy procedures in 2,726 patients pneumothorax occurred in 27.2 per cent of the patients. Only 7.7 per cent required exsufflation or drainage. The factors influencing the relative frequency and the severity of pneumothorax are discussed. Bleeding around the punctured lesions was found in 11 per cent, and hemoptysis in 2 per cent but were of no clinical importance. In one case evidence of needle track implantation was found. The theoretical and practical importance of tumour cell spread and spread of infection through the needle track is discussed. No air embolism or mortality occurred.