Subba R Digumarthy1, Bojan Kovacina2, Alexi Otrakji3, Michael Lanuti4, Jo-Anne O Shepard3, Amita Sharma3. 1. Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States. Electronic address: sdigumarthy@mgh.harvard.edu. 2. McGill University, Montreal General Hospital, Department of Radiology, Montreal, Canada. 3. Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States. 4. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States.
Abstract
PURPOSE: To assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN). METHOD AND MATERIALS: We analyzed PTNAB of 74 lung lesions (mean size: 3.6 ± 2.1 cm) in 74 patients (M: F 38:36; age 68 ± 15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65 ± 14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35 mm Hg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications. RESULTS: Fine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7). CONCLUSION: Percutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications.
PURPOSE: To assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN). METHOD AND MATERIALS: We analyzed PTNAB of 74 lung lesions (mean size: 3.6 ± 2.1 cm) in 74 patients (M: F 38:36; age 68 ± 15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65 ± 14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35 mm Hg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications. RESULTS: Fine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7). CONCLUSION: Percutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications.
Authors: Piera C Robson; David O'Connor; Perri Pardini; Terrah F Akard; Mary S Dietrich; Alan Kotin; Alexandra Solomon; Mohit Chawla; Matthew Kennedy; Stephen B Solomon Journal: J Radiol Nurs Date: 2021-05-25