title: Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases.
abstract: OBJECTIVE
  To evaluate the frequency and severity of pulmonary hemorrhage after transthoracic needle lung biopsy (TTLB) and assess possible factors associated with pulmonary hemorrhage.
  
  
  METHODS
  This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Records from 1113 patients who underwent 1175 TTLBs between January 2008 and April 2013 were retrospectively reviewed. Primary outcomes were pulmonary hemorrhage, documented hemoptysis, and bleeding complications necessitating intervention. Pulmonary hemorrhage was graded as follows: 0, none; 1, less than or equal to 2 cm around the needle; 2, more than 2 cm and sublobar; 3, at least lobar; and 4, hemothorax. Patient, technique, and lesion-related variables were evaluated as predictors of pulmonary hemorrhage. Patient-related variables included main pulmonary artery diameter (mPAD) at computed tomography (CT), pulmonary artery pressures at echocardiography and right-sided heart catheterization, medications, chronic lung disease, bleeding diathesis, and immunodeficiency. Technique- and lesion-related variables included needle gauge, number of passes, pleura-needle angle, lesion size and morphologic characteristics, and distance to pleura. Univariate analysis was performed with χ(2), Fisher exact, and Student t tests.
  
  
  RESULTS
  Pulmonary hemorrhage occurred in 483 of the 1175 TTLBs (41.1%); hemoptysis was documented in 21 of the 1175 TTLBs (1.8%). Higher-grade hemorrhage (grade 2 or higher) occurred in 201 of the 1175 TTLBs (17.1%); five of the 1175 TTLBs (0.4%) necessitated hemorrhage-related admission. Higher-grade hemorrhage was more likely to occur with female sex (P = .001), older age (P = .003), emphysema (P = .004), coaxial technique (P = .025), nonsubpleural location (P < .001), lesion size of 3 cm or smaller (P < .001), and subsolid lesions (P = .028). Enlarged mPAD at CT (≥2.95 cm) was not significantly associated with higher-grade hemorrhage (P = .430).
  
  
  CONCLUSIONS
  Pulmonary hemorrhage after TTLB is common but rarely requires intervention. An enlarged mPAD at CT may not be a risk factor for higher-grade hemorrhage.
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tai
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Dunne
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Trotman-Dickenson
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Francine L
authors.initials: FL
authors.lastname: Jacobson
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Rachna
authors.initials: R
authors.lastname: Madan
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.affiliation: From the Department of Radiology (R.T., R.M.D., B.T.D., F.L.J., R.M., K.K.K., A.R.H.) and Division of Thoracic Imaging (R.M.D., B.T.D., F.L.J., R.M., A.R.H.), Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
authors.forename: Andetta R
authors.initials: AR
authors.lastname: Hunsaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*