title: Ipsilateral opposite-side aspiration in resistant pneumothorax after CT image guided lung biopsy: complementary role after simple needle aspiration.
abstract: BACKGROUND
  The goal of this study was to evaluate the efficacy of ipsilateral opposite-side aspiration, a new method to overcome resistant pneumothorax after failure of a simple aspiration. The patient position is reversed (from prone to supine or vice versa) and the aspiration repeated.
  
  
  METHODS
  Between January 1, 2010, and April 3, 2012, 129 consecutive, CT image-guided, percutaneous needle biopsies of lung nodules were performed in 127 patients (75 men, 52 women; mean age, 67.8 years; range, 26-88 years). Two patients underwent repeated biopsies. The mean lesion diameter was 38 mm (range, 8-110 mm). Core biopsy and fine-needle aspiration (FNA) were performed in 126 procedures; in three cases, only FNA was performed. In the cases with symptomatic minimal pneumothorax and in all patients with pneumothorax &gt; 10 mm, immediate, simple, manual aspiration was performed. Ipsilateral opposite-side aspiration was performed when simple aspiration failed.
  
  
  RESULTS
  Among 129 CT image-guided biopsies, pneumothorax was detected by CT scan in 54 (42%); 51 (39%) were detected during the biopsy. Delayed pneumothorax occurred in two patients (1.55%). Manual aspiration to treat pneumothorax was performed in 27 of 129 procedures (21%). Simple aspiration was successful in 20 of these 27 cases (74%). Ipsilateral opposite-side aspiration was accomplished in the remaining seven cases (26%) and was successful in six cases (86%). Two of 129 procedures (1.55%) required chest tube placement.
  
  
  CONCLUSIONS
  Immediate, simple, percutaneous aspiration of iatrogenic pneumothorax was successful in 74% of patients needing treatment. Our proposed new method of ipsilateral opposite-side aspiration offers a solution for patients who remain with resistant pneumothorax after simple aspiration.
authors.affiliation: Departments of Radiology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Yaffe
authors.affiliation: Pulmonary Medicine, Meir Medical Center, Kfar Saba, Israel. Electronic address: davids3@clalit.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
authors.affiliation: Oncology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Maya
authors.initials: M
authors.lastname: Gottfried
authors.affiliation: Departments of Radiology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bartal
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D013396:Suction / Q000379:methods; D014057:Tomography, X-Ray Computed