title: Percutaneous CT guided lung biopsy in patients with pulmonary hypertension: Assessment of complications.
abstract: OBJECTIVE
  To assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN).
  
  
  METHODS
  We analyzed PTNAB of 74 lung lesions (mean size: 3.6 ± 2.1 cm) in 74 patients (M: F 38:36; age 68 ± 15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65 ± 14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35 mm Hg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications.
  
  
  RESULTS
  Fine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7).
  
  
  CONCLUSIONS
  Percutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications.
authors.affiliation: Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States. Electronic address: sdigumarthy@mgh.harvard.edu.
authors.forename: Subba R
authors.initials: SR
authors.lastname: Digumarthy
authors.affiliation: McGill University, Montreal General Hospital, Department of Radiology, Montreal, Canada.
authors.forename: Bojan
authors.initials: B
authors.lastname: Kovacina
authors.affiliation: Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States.
authors.forename: Alexi
authors.initials: A
authors.lastname: Otrakji
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.affiliation: Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States.
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.affiliation: Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 213, Boston, MA 02114, United States.
authors.forename: Amita
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000401:mortality*
keywords: Biopsy; CT; Chest; Lung nodules; Pulmonary hypertension