Pneumothorax Following Transbronchial Biopsy
Transbronchial biopsy via the flexible fiberoptic bronchoscope is a common procedure in pulmonary medicine. Because pneumothorax is a recognized complication of this procedure, most bronchosco- pists routinely obtain chest roentgenograms after TBB. However, the proportion of these routine chest x-ray films which demonstrate an unsuspected pneumothorax is unknown. We hypothesized that routine post- biopsy chest roentgenograms rarely demonstrate a pneumothorax in patients who have no symptoms or fluoroscopic evidence of lung collapse. To test this hypothesis, we studied 305 consecutive patients undergoing fluoroscopically guided TBB all of whom had a postbiopsy chest roentgenogram.
Methods
We reviewed the medical records and chest roentgenograms of 305 consecutive patients undergoing fiberoptic bronchoscopy with fluoroscopically guided TBB. These 305 patients were all the patients undergoing fiberoptic bronchoscopy with fluoroscopically guided TBB at the University of Virginia Health Sciences Center between January 1983 and November 1988. The bronchoscopies and TBB were performed by eight pulmonary fellows supervised by six attending physicians from the Division of Pulmonary Medicine at the University of Virginia.
Table 1—Indications for Transbronchial Biopsies
|
Pulmonary |
50% |
|
Mass or lung |
22% |
|
Hemoptysis |
5% |
|
Hilar adenopathy |
5% |
|
Miscellaneous |
18% |
All biopsies were done using a C-arm fluoroscope with the patient in the supine position. The major indications for transbronchial biopsy are listed in Table 1. The number of biopsy specimens obtained per procedure was specified in 166 of the 305 patients; the median was five biopsy specimens per patient (range one to eight). The locations of the biopsy specimens were specified in all cases and are shown in Table 2. Immediately after the bronchoscopy, each patient was checked for a pneumothorax with 10 to 15 seconds of fluoroscopy in the bronchoscopy suite. In addition, each patient had a chest roentgenogram taken within four hours of the procedure. One of the authors (TP), a radiologist who was unaware of the patients clinical course, reviewed each chest x-ray film.
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Table 2—Location of Transbronchial Biopsies
|
Right lung |
|
|
Right upper lobe |
21% |
|
Middle lobe |
5% |
|
Right lower lobe |
33% |
|
Left lung |
|
|
Left upper lobe |
10% |
|
Lingula |
2% |
|
Left lower lobe |
21% |
|
Two or more lobes |
8% |
To estimate how often chest pain and fluoroscopic findings of lung collapse occurred in patients with a pneumothorax, these clinical findings were recorded in all patients with a pneumothorax. While this information was not recorded in all patients without a pneumothorax, one author (WF) documented the presence or absence of chest pain and fluoroscopic findings of a lung collapse in 42 of these patients without pneumothorax. This subgroup provides an estimate of how often these clinical findings occur in patients without pneumothorax.
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