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Published on: July 19, 2024
CT-guided percutaneous lung biopsy under general anesthesia: a pediatric case series and literature review
Heather Naumann1, Andy Pittaway, Anne M Lynn
1Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA.
Insights
Computed tomography-guided percutaneous lung biopsy (CT-PLB) in children carries a high risk of complications, including pulmonary hemorrhage and pneumothorax. General anesthesia with an endotracheal tube may aid airway management during this procedure.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Imaging
Background:
- Computed tomography-guided percutaneous lung biopsy (CT-PLB) is an important diagnostic tool in pediatric patients.
- General anesthesia is often employed for CT-PLB in children to ensure patient comfort and immobility.
Purpose of the Study:
- To evaluate the complication rates and outcomes of CT-PLB performed under general anesthesia in a pediatric population.
- To identify factors associated with complications and assess the utility of airway management strategies.
Main Methods:
- Retrospective review of 14 consecutive pediatric patients undergoing CT-PLB under general anesthesia over 18 months.
- Data collection included procedure details, complications (pulmonary hemorrhage, pneumothorax), and management strategies.
Main Results:
- The overall complication rate was 64%, with pulmonary hemorrhage (36%) and pneumothorax (29%) being most frequent.
- Complications were linked to both patient-specific and procedural factors.
- The presence of an endotracheal tube facilitated immediate airway management during complications.
Conclusions:
- CT-PLB in children under general anesthesia is associated with a high incidence of overall and severe complications.
- Proactive airway management with an endotracheal tube is recommended.
- Availability of intensive care unit (ICU) admission should be ensured prior to the procedure due to potential severe complications.
Abstract:
We describe 14 consecutive children who received computed tomography-guided percutaneous lung biopsy (CT-PLB) under general anesthesia over an 18-month period at our institution. Pulmonary hemorrhage (occurring in 36%) and pneumothorax (29%) were the two most common complications; the overall complication rate was 64%. When complications did occur, immediate airway management was facilitated by the presence of an endotracheal tube (ETT). We conclude as follows: (i) CT-PLB in our series is associated with a high risk of both overall and severe complications; (ii) risk of complications is increased by both patient and procedure-related factors; (iii) airway management with ETT may be preferable should a complication arise; (iv) severe complications may necessitate ICU admission, which should be available before proceeding.
