POST-CT-GUIDED BIOPSY PNEUMOTHORAX, ACCORDING TO THE COAXIAL TECHNIQUE WITH AN 18-GAUGE NEEDLE: EPIDEMIOLOGICAL,...

Transthoracic CT-guided biopsy performed with the coaxial technique is a minimally invasive procedure that facilitates the diagnosis of lung lesions (nodules or masses) and/or mediastinopulmonary lesions suspected of malignancy. This procedure is the source of several complications, the most frequent of which is pneumothorax.

To describe the epidemiological, diagnostic, and therapeutic aspects of iatrogenic pneumothorax after CT-guided biopsy performed using the coaxial technique.

Prospective longitudinal study, conducted over a period of 2 years and 10 months, from April 1, 2023, to February 1, 2026, at the Mohammed V Military Teaching Hospital in Rabat, including all patients who presented with a pneumothorax following a transthoracic CT-guided biopsy, according to the coaxial technique, confirmed clinically and/or radiologically.

The study included 30 cases of pneumothorax following CT-guided biopsy according to the coaxial technique. Biopsies were performed in 217 patients, and the incidence of pneumothorax was 13.8%. The median age was 68 years [58.8-71.5], with a predominance of males (90%). The most frequent characteristics observed among patients with pneumothorax were pulmonary emphysema (73.3%), lower-lobe lesions (33.3%), and central lesions with a median depth of 3.6 cm [2.9-4.2]. Procedure-related characteristics included practitioner status and biopsy needle diameter (18-gauge). Most patients were asymptomatic (60%). Diagnosis was established by chest CT during the procedure in 26.7% of cases and by chest X-ray after the procedure in 73.3% of cases. Small pneumothorax was the most common presentation (40%). Treatment was conservative in 53.3% of cases, and intervention was required in 46.7% (7 cases drained and 7 cases exsufflated). A complication was observed in 5 cases, after initial treatment. Only one patient underwent thoracoscopic pleurodesis after 14 days of chest drainage. The median length of hospital stay was 4 days [2-5.75].

Pneumothorax is a major complication of CT-guided transthoracic biopsy, whether performed coaxially or non-coaxially. In our descriptive series, pulmonary emphysema, lower-lobe location, and lesion depth were frequent characteristics among patients who developed pneumothorax. We believe that the radiologist's experience is a determining factor in preventing a very high incidence of pneumothorax cases.