Protective pneumothorax for needle biopsy of mediastinum and pulmonary hilum

The risk of performing CT-guided transthoracic needle biopsy of some mediastinal and pulmonary hilar masses is increased by the presence of intervening lung. A series of patients is presented in whom a protective pneumothorax provided access for biopsy of masses in the mediastinum and pulmonary hilum. Review of Interventional Radiology records revealed 24 patients who had biopsies of mediastinum or pulmonary hilum, in whom protective pneumothorax was used, or attempted, to provide percutaneous access for biopsy. Characteristics of these patients and their procedures were reviewed. Percutaneous access to the pleural space was gained in 21/24 (88%) of patients. A protective pneumothorax was established in 19 (79%); 2 patients had pleural adhesions that prevented the lung from being displaced. The process of creating the protective pneumothorax added a mean time of 17 minutes to the procedure (range 6-30 minutes). All patients had biopsy using coaxial technique, with either a 20-gauge or 18-gauge core biopsy instrument, in addition to needle aspiration. Air leak requiring tube drainage occurred in 1/19 (5%) of patients who had a protective pneumothorax, and in 2/5 (40%) of patients in whom protective pneumothorax was not established. Percutaneous creation of a protective pneumothorax is a safe method that provides access for needle biopsy of deep lesions in the chest without traversing aerated lung.