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Lung Nodule CT Guided Needle Biopsy

Lung Nodule CT Guided Needle Biopsy

December 13, 2021
Emily Cassidy, MD
Emily Cassidy, MD

Cardiothoracic Surgery

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So with regard to CT guided needle biopsies, which is where the needle is injected through the chest wall from the outside, one of the biggest concerns we have there is what’s called a pneumothorax. There’s about a 10 to 15% chance of that occurring, which is where, as you can imagine, you’re sort of going through an air filled sponge with a needle. Every once in a while, you’re going to pop one of those air sacs. Air will leak out into the chest and you’ll develop an accumulation of air between the lung and the chest wall. When that accumulation of air occurs, it’s going to exert pressure and the lung is more sensitive to pressure than the chest wall. So the lung gets pushed toward the center while that air fills up that side of the chest. Typically the treatment for that is to have a chest tube placed, which will evacuate the air and hopefully allow for the lung to heal. The other things that we worry about just like with any other intervention is bleeding and also not getting the answer, like I mentioned particularly with small lesions, lesions that are harder to reach, and because the lung is moving, it can be a challenge to get an answer from a needle biopsy. We also have the problem that unlike other solid organs, unlike the liver or the spleen, the lungs move. Even with a perfect breath hold, our lungs are moving because they’re touching our heart and we can’t hold the heartbeat. We have to keep having our heartbeat the entire time. So there is some motion that’s difficult to account for. So particularly for a small lesion or one that’s not completely solid, needle biopsy can be challenging.