Shawn DeWayne Teague MD, Presenter: Nothing to Disclose

Cristopher Andrew Meyer MD, Abstract Co-Author: Nothing to Disclose

Darel Edward Heitkamp MD, Abstract Co-Author: Nothing to Disclose

Dewey James Conces MD, Abstract Co-Author: Nothing to Disclose

Transthoracic needle aspiration biopsy (TTNA) is a well-accepted method for evaluation of focal parenchymal abnormalities in the chest. Pneumothorax remains the most common complication with a reported incidence of 20-40%. While prior studies have suggested this rate may be decreased with the use of an autologous blood patch (ABP), this technique has not gained widespread acceptance.

A retrospective review was performed of all TTNA procedures performed at our institution from January 1998 to July 2001 prior to initiation of ABP (control group) and from August 2001 to July 2003 subsequent to the initiation of the ABP (study group). All biopsies were performed under the supervision of two thoracic radiologists with greater than 30 years of combined experience with TTNA. All cases were reviewed for size of lesion, depth from the pleural surface and the number of visceral pleural layers traversed. Severity of adjacent emphysema was noted. Pneumothorax rates and sizes, as well as, chest tube rates were recorded. Lesions in the chest wall, mediastinum or abutting the pleural surface were excluded when the biopsy path failed to traverse aerated lung.

A total of 407 procedures were performed in the control group and 237 in the study group. 123 pneumothoraces (30%) were observed in the control group with 112 representing nontrivial pneumothoraces (28%) and 23 requiring chest tubes (5.7%). In the study group, there were 52 pneumothoraces (22%), 35 nontrivial pneumothoraces (15%) and 5 requiring chest tubes (2%). All differences were statistically significant using a two-sided z-test with a p value less than 0.02 for all pneumothoraces, 0.0002 for nontrivial pneumothoraces, and 0.03 for chest tube placement.

Use of an autologous blood patch following a TTNA procedure is a simple, effective means of decreasing the rate of pneumothorax and chest tube placement.

S.D.T.,D.E.H.,D.J.C.: Department of Radiology Indiana University School of Medicine receives research and educational grants from Philips Medical Systems, Cleveland, Ohio. : Shawn Teague, Darel Heitkamp, and Dewey Conces

Teague, S, Meyer, C, Heitkamp, D, Conces, D, Decrease in Pneumothorax Occurrences and Chest Tube Placement Using an Autologous Blood Patch at Completion of Transthoracic Needle Aspiration Biopsies: A Retrospective Analysis.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4410259.html