"CT guided thoracic biopsy is performed for the diagnosis of suspected neoplasia of the lung, pleural, or mediastinum, or for microbiology in the case of lung or pleural cavity infections. It can be performed as a day procedure if patient monitoring and complications support are available. Peripheral lung and pleural biopsies may sometimes be performed under ultrasound guidance."
"pulmonary lesion >8 mm with suspicious/malignant features11"
"suspected metastasis12"
"platelet > 50,000/mm3"
"Pre-procedure evaluation"
"post-obstructive atelectasis"
"Post-procedure care"
"alveolar haemorrhage: may be seen in ~10% (range 5-16.9%) and haemoptysis: occurs in 1-5% of patients 4. Initiate suction, oxygen and dependent positioning of the affected lung as required; diagnostic CT, bronchoscopy, embolisation or surgery may be necessary! Risk factors include:"
"the reported rate of pneumothorax varies widely from 8-64% 6"
"core biopsy versus FNA"
Expected headings
"Laboratory parameters for a safe procedure"
"Pre-procedure evaluation"
"Positioning"
"Biopsy"
"Post-procedure care"
"normal prothrombin time (PT) and partial thromboplastin time (PTT); (some studies suggest this does not predict lack of significant haemorrhage 3)"
"Position the patient to allow easy access and needle manipulation (low table position in CT). Avoid placing drapes over the patient's face (head in the gantry avoids this). If required, the patient's arms can be raised to widen the intercostal spaces. Some advocate positioning the patient with the lesion inferior to reduce the incidence of pneumothorax 9 however this will limit access. The patient must be comfortable; they will need to be still for about 30 minutes. Give oxygen if required and monitor oxygen saturation."
"monitor pneumothorax for enlargement; if it is sizeable but stable, it can be aspirated, if it is increasing, insert a small (e.g. 8Fr) pleural drain under CT-guidance"
"pneumothorax; if treatment required, direct drain to apex and attach to water seal"
"alveolar haemorrhage: may be seen in ~10% (range 5-16.9%) and haemoptysis: occurs in 1-5% of patients 4. Initiate suction, oxygen and dependent positioning of the affected lung as required; diagnostic CT, bronchoscopy, embolisation or surgery may be necessary! Risk factors include:"
"haemothorax, usually indicates injury to intercostal vessels or internal thoracic artery or vein; direct drain posteroinferiorly and attach to water seal system; embolisation may be required"
"haemothorax, usually indicates injury to intercostal vessels or internal thoracic artery or vein; direct drain posteroinferiorly and attach to water seal system; embolisation may be required"
"gas embolism is rare (up to 0.2% of patients 5) and more likely if using a non-valved coaxial needle inadvertently placed in a pulmonary vein; small volumes of gas can occlude a coronary or cerebral vessel and can be treated by 100% oxygen, Trendelenburg and left lateral decubitus positioning. Risk factors include:"
"tumour seeding is rare but more likely with multiple punctures, pleural tumours such as mesothelioma; this can be excised , treated by radiofrequency ablation or radiotherapy"
"non-diagnostic biopsy; rates vary depending on sampling error and lesion type. Biopsy can be repeated and cytology with on-site evaluation may be helpful 10"
"There is a growing trend for ambulatory lung biopsy, in which case the patient has the procedure performed as an outpatient without admission to hospital.7"
"alveolar haemorrhage: may be seen in ~10% (range 5-16.9%) and haemoptysis: occurs in 1-5% of patients 4. Initiate suction, oxygen and dependent positioning of the affected lung as required; diagnostic CT, bronchoscopy, embolisation or surgery may be necessary! Risk factors include:"
"alveolar haemorrhage: may be seen in ~10% (range 5-16.9%) and haemoptysis: occurs in 1-5% of patients 4. Initiate suction, oxygen and dependent positioning of the affected lung as required; diagnostic CT, bronchoscopy, embolisation or surgery may be necessary! Risk factors include:"
"gas embolism is rare (up to 0.2% of patients 5) and more likely if using a non-valved coaxial needle inadvertently placed in a pulmonary vein; small volumes of gas can occlude a coronary or cerebral vessel and can be treated by 100% oxygen, Trendelenburg and left lateral decubitus positioning. Risk factors include:"