Transthoracic needle aspiration in patients with severe emphysema. A study of lung transplant candidates.
OBJECTIVE
To describe the risks of transthoracic needle aspiration (TTNA) in a population of patients with severe lung disease: candidates for lung transplantation.


METHODS
Eight of 190 patients evaluated for lung transplantation underwent TTNA of nine pulmonary nodules (mean diameter, 14 mm; range, 0.8 to 2.2 cm). We evaluated pneumothorax rate, chest tube rate, duration of placement, and pulmonary function test results.


RESULTS
All patients had emphysema; two had alpha 1-antitrypsin deficiency. The mean FEV1 of all patients was 0.64 L (22% of predicted; range, 17 to 28%), indicating severe air-flow obstruction. Six patients required a chest tube (50%); three chest tubes were placed emergently on the CT scanner table. Three patients required a second chest tube for persistent air leak. Tubes were in place for 1 to 22 days (mean, 10 days). One patient had chest tubes for 22 days and required intubation.


CONCLUSIONS
TTNA in patients with marked emphysema is complicated by a high incidence of pneumothorax, rapid development of tension pneumothorax and chest tube placement. Since nodules in lung transplant candidates may represent bronchogenic carcinoma, serial CT scans to demonstrate lesion stability or growth, or thoracoscopic resection should be considered as an alternate approach to TTNA to avoid the significant morbidity of the procedure in these patients.
Kazerooni
E A
EA
Department of Radiology, University of Michigan Medical Center, Ann Arbor, 48109-0326, USA.
Hartker
F W
FW
Whyte
R I
RI
Martinez
F J
FJ
Lynch
J P
JP
D000328:Adult; D001707:Biopsy, Needle / Q000009:adverse effects; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed