title: CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage?
abstract: OBJECTIVE
  We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax.
  
  
  METHODS
  We reviewed the CT images of 538 patients (364 males and 174 females, mean age 70 years, range 36-90 years) who underwent CT-guided TTFNA of pulmonary nodules between January 2008 and September 2013. The following CT findings were assessed: pulmonary hemorrhage (type 1, along the needle track; type 2, perilesional; low-grade, ≤6 mm; high-grade, >6 mm), pneumothorax, distance between the target nodule and the pleural surface, and emphysema.
  
  
  RESULTS
  Pneumothorax occurred in 154 cases (28.6%) and pulmonary hemorrhage occurred in 144 cases (26.8%). The incidence of pneumothorax was lower in patients showing type 1 and high-grade pulmonary hemorrhage pattern. The incidence of pneumothorax in biopsies ≥30 mm from pleural surface was 26% (12/46) in cases showing this pattern, while it was 71.4% (30/42) when this pattern was not seen. Similarly, the incidence of pneumothorax in biopsies <30 mm from the pleural surface was 0% (0/28) in cases showing this hemorrhage pattern, while it was 19% (76/394) when this pattern was not seen.
  
  
  CONCLUSIONS
  Pulmonary hemorrhage during TTFNA is a frequent event that protects against pneumothorax. A bleeding greater than 6 mm along the needle track is associated with lower incidence of pneumothorax, especially in biopsies deeper than 3 cm.
authors.affiliation: Department of Surgical Sciences, Section of Diagnostic Imaging, University Hospital of Parma, Parma, Italy. lukas_red@hotmail.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: De Filippo
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.forename: Mario
authors.initials: M
authors.lastname: Silva
authors.forename: Raffaella
authors.initials: R
authors.lastname: Zagaria
authors.forename: Giorgio
authors.initials: G
authors.lastname: Concari
authors.forename: Rita
authors.initials: R
authors.lastname: Nizzoli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bozzetti
authors.forename: Marcello
authors.initials: M
authors.lastname: Tiseo
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.forename: Stefano
authors.initials: S
authors.lastname: Lipia
authors.forename: Ilaria
authors.initials: I
authors.lastname: Paladini
authors.forename: Luca
authors.initials: L
authors.lastname: Macarini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.forename: Antonio
authors.initials: A
authors.lastname: Rotondo
authors.forename: Cristina
authors.initials: C
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D061705:Image-Guided Biopsy; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000209:etiology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000517:prevention & control; D015641:Radiography, Interventional; D012307:Risk Factors; D014057:Tomography, X-Ray Computed