Intervention in patients with pneumothorax immediately following CT-guided fine needle aspiration of pulmonary nodules.
BACKGROUND: The incidence of pneumothorax (PTX) as a complication of computerized tomography guided fine needle aspirates (CT-FNA) of solitary pulmonary nodules (SPN) varies from 8-61%. It has been suggested that the practice of obtaining a delayed chest radiograph in patients who have undergone CT-FNA of SPN is not cost effective and adds little information concerning lung expansion obtained by CT at the end of the procedure. It, however, is not known what percent of patients with a PTX present immediately after CT-FNA but do not require prompt chest tube placement will progress and require intervention later. MATERIAL/METHODS: One hundred-fifty-eight consecutive patients undergoing CT-FNA of SPN were included in the study. Immediately after CT-FNA each patient was reimaged with the CT scanner to check for PTX. Patients with a PTX immediately after CT-FNA were assessed as to whether intervention was undertaken or whether the PTX enlarged and/or required drainage at a later time. RESULTS: Thirty-eight patients developed a PTX while still on the CT scanner. Twenty-nine patients with an immediate PTX did not require drainage of their pleural space. Chest tube placement was required promptly after the CT-FNA in 4 patients. Five patients had their pleural space drained at a later time due to an increasing size of the PTX and/or the development of symptoms attributed to the PTX. CONCLUSIONS: These data suggest that patients who develop a PTX immediately after CT-FNA but who do not require prompt pleural space evacuation should be followed closely both clinically and radiographically.