Ryan Tai MD, Presenter: Nothing to Disclose

Ruth M. Dunne MBBCh, Abstract Co-Author: Nothing to Disclose

Beatrice Trotman-Dickenson FRCR, MRCP, Abstract Co-Author: Nothing to Disclose

Rachna Madan MD, Abstract Co-Author: Nothing to Disclose

Francine L. Jacobson MD, MPH, Abstract Co-Author: Nothing to Disclose

Andetta Rotilla Hunsaker MD, Abstract Co-Author: Nothing to Disclose

To evaluate the incidence of pulmonary hemorrhage during TTNLB and investigate possible predictors for significant hemorrhage.

Records of 1,113 patients who underwent 1,175 TTNLB procedures from January 1, 2008 to April 22, 2013 were retrospectively reviewed after IRB approval. Studied patient-related factors included pulmonary artery systolic (PASP) and pulmonary artery (PAP) pressures from echocardiogram and cardiac catheterization data; medications including anticoagulants, antiplatelets, and steroids; coagulation studies; and history of pulmonary hypertension, bleeding diathesis, or immunodeficiency. CT images and reports were reviewed for biopsy-related factors including lesion size, location, morphology, and distance to pleura; needle gauge; angulation to pleura; number of passes; pulmonary artery (PA) size; and chronic lung disease. Post-biopsy images were evaluated for pulmonary hemorrhage, which was graded: 0, none; 1, ≤2cm around needle tract; 2, >2 cm but sublobar; 3, lobar; 4, >lobar or hemothorax. Primary outcomes were pulmonary hemorrhage or documented hemoptysis. Univariate analysis with chi-square, Fisher’s exact, and student’s t tests was used to evaluate study variables as predictors for pulmonary hemorrhage.

Grade 1 hemorrhage occurred in 282 cases (24%). Significant hemorrhage, defined as greater than grade 1 hemorrhage, occurred in 200 cases (17%). Twenty (1.7%) had documented hemoptysis and four (0.3%) were admitted due to hemorrhage. Significant hemorrhage was more likely to occur in females (p=0.0017), with older age (p=0.0005), emphysema (p=0.0036), coaxial technique (p=0.039), and lesion size <3cm (p<0.0001), and less likely with subpleural lesions (p<0.0001). Hemorrhage occurred more frequently in subsolid lesions and less commonly in consolidation (p=0.0002). PA size, elevated PAP or PASP, immunodeficiency, and use of antiplatelets, anticoagulants, or steroids were not predictors for pulmonary hemorrhage.

Significant pulmonary hemorrhage is more likely in females, with coaxial technique, older age, and smaller and subsolid lesions, and less likely with subpleural lesions. Patients with suspected pulmonary hypertension may not be at increased risk for pulmonary hemorrhage after TTNLB.

Pulmonary hemorrhage is common after TTNLB, but rarely requires intervention. TTNLB can be performed safely in patients with suspected pulmonary hypertension.

Tai, R, Dunne, R, Trotman-Dickenson, B, Madan, R, Jacobson, F, Hunsaker, A, Incidence and Predictors of Pulmonary Hemorrhage in Patients Undergoing Percutaneous Computed Tomography (CT)-Guided Transthoracic Needle Lung Biopsy (TTNLB): Single Institution Experience of 1,175 Cases.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005431.html