[The treatment of iatrogenic pneumothorax with small-gauge catheters. The author's personal experience in 30 cases].
OBJECTIVE
Pneumothorax (PNX) is the most frequent complication in patients who have undergone lung biopsy. If PNX is asymptomatic and < 30%, it does not require treatment, while if it is > 30% and the patient is symptomatic treatment is needed. As a rule surgery is required and patients are hospitalized and undergo intrathoracic drainage with positioning of a large gauge catheter--i.e. over 15 French (F). In the last 10 years radiologists have begun treating PNX with much smaller catheters (7-10 F). We report the execution technique using 6.3 F catheters and the results obtained in 30 patients with symptomatic iatrogenic PNX and/or iatrogenic PNX > 30%.


METHODS
All the patients underwent CT-guided lung biopsy. Immediately after the procedure some follow-up scans were performed and a further expiratory radiograph with the patient in upright position was carried out after at least 2 hours. If an asymptomatic PNX < 30% was found the patient was discharged and submitted to radiographic follow-up the following morning and every 24 hours thereafter for 2 days. If there was a symptomatic PNX and/or a PNX > 30% an intrathoracic drainage catheter was positioned. Under fluoroscopic or CT guidance we positioned a 5.7 F intrathoracic pig-tail catheter at a point corresponding to the 3rd or 4th intercostal space on the midclavear line. After manual suction of intrathoracic air we connected the catheter to a Hemlick valve and repeated the chest radiograph 4 hours later. If the PNX had not reformed the patient was discharged and submitted to radiographic follow-up every 24 hours for 3-5 days. On the contrary if the PNX had reformed, or if pain and/or dyspnea symptoms or signs persisted, the catheter was connected to a continuous-suction system and the patient rehospitalized for about 6 days. Oximetry was performed in all patients before biopsy, on PNX diagnosis, and after pulmonary re-expansion.


RESULTS
All the cases were resolved and 9 patients were followed-up in the outpatients department. Drainage had to be repeated in 2 patients only and the 5.7 F catheters replaced with an 8 F and a 10 F catheters. Oximetric data were always correlated with the presence/absence of PNX. In particular, in PNX > 30% we found over 10% reduction relative to prebiopsy values. This datum was corrected and came to meet the prebiopsy value as soon as the lung was re-expanded. No significant changes were seen in PNX < 30%.


CONCLUSIONS
Small gauge catheters provide the following advantages: the procedure presents a low risk of complications, is easy to carry out and much better tolerated by the patient; also in some cases the cost is lower because no hospitalization is required. The close correlation of oximetric values with the presence/absence of PNX < 30% could be considered to decrease follow-up radiographic examinations. Finally the possibility of treating iatrogenic PNX using radiological techniques further promotes the acceptability of lung biopsy by colleagues from other branches of medicine.
Pancione
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Servizio di Radiologia, Ospedale Civile Maria Vittoria, ASL 3, Torino.
D001707:Biopsy, Needle / Q000009:adverse effects; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015641:Radiography, Interventional; D013997:Time Factors; D014057:Tomography, X-Ray Computed