Pneumothorax and dependent versus nondependent patient position after needle biopsy of the lung

To test the hypothesis that placing the patient in a position with the puncture site dependent (down) after transthoracic needle biopsy reduces the incidences of pneumothorax and of pneumothorax that requires chest tube placement.

Four hundred twenty-three needle biopsies of the lung were performed in 390 patients from October 1991 to August 1994 with computed tomographic guidance, fluoroscopic guidance, or both. Two hundred forty-two biopsies were performed from the posterior approach, 166 from the anterior approach, and 15 from the lateral approach. The patients were assigned on an alternating basis to either the puncture-site-dependent recumbent position (210 biopsies) or the puncture-site-nondependent recumbent position (213 biopsies) for at least 1 1/2 hours after biopsy.

No significant differences were found in either the incidence of pneumothorax (dependent position, 62 of 210 biopsies [30%], vs nondependent position, 57 of 213 biopsies [27%]; P = .60) or the incidence of pneumothorax that required chest tube placement (dependent position, 10 of 210 biopsies [5%], vs nondependent position, six of 213 biopsies [3%]; P = .43).

The results suggest that the puncture-site-down postbiopsy position may not affect either the incidence of postbiopsy pneumothorax or the incidence of pneumothorax that requires chest tube placement.