title: Protective Capnothorax During Transthoracic Needle Biopsy.
abstract: OBJECTIVE
  Transthoracic needle biopsy (TTNB) is an established procedure in the management of pulmonary nodules. The most common complications are directly related to crossing the lung or visceral pleura during the biopsy. In this study, we describe the use of carbon dioxide instead of room air to create a protective "capnothorax" during TTNB.
  
  
  METHODS
  Five patients underwent creation of a capnothorax during TTNB. Parameters recorded were location and size of target, distance from pleura, length of procedure, volume of carbon dioxide, periprocedural complications and biopsy result.
  
  
  RESULTS
  Induction of capnothorax was successful in all cases. In two patients, a continuous infusion of carbon dioxide was required to maintain an adequate volume of intrapleural gas. In two patients, the carbon dioxide resolved spontaneously and in the remaining patients it was aspirated at the end of the procedure. All biopsies were diagnostic with no periprocedural or postprocedural complications.
  
  
  CONCLUSIONS
  This study suggests that protective iatrogenic capnothorax is a safe and effective technique during TTNB. The intrinsic properties and availability of carbon dioxide make it an attractive alternative to room air.
authors.affiliation: Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. jokavana@tcd.ie.
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-8898-8636
authors.initials: J
authors.lastname: Kavanagh
authors.affiliation: Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Miranda L
authors.initials: ML
authors.lastname: Siemienowicz
authors.affiliation: Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyen
authors.affiliation: Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kandel
authors.affiliation: Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Patrik
authors.initials: P
authors.lastname: Rogalla
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle / Q000379:methods; D002245:Carbon Dioxide / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D002245:Carbon Dioxide
keywords: Capnothorax; Percutaneous; Transthoracic needle biopsy