Ipsilateral opposite-side aspiration in resistant pneumothorax after CT image guided lung biopsy: complementary role after simple needle aspiration.

Background: The goal of this study was to evaluate the efficacy of ipsilateral opposite-side aspiration, a new method to overcome resistant pneumothorax after failure of a simple aspiration. The patient position is reversed (from prone to supine or vice versa) and the aspiration repeated.

Methods: Between January 1, 2010, and April 3, 2012, 129 consecutive, CT image-guided, percutaneous needle biopsies of lung nodules were performed in 127 patients (75 men, 52 women; mean age, 67.8 years; range, 26-88 years). Two patients underwent repeated biopsies. The mean lesion diameter was 38 mm (range, 8-110 mm). Core biopsy and fine-needle aspiration (FNA) were performed in 126 procedures; in three cases, only FNA was performed. In the cases with symptomatic minimal pneumothorax and in all patients with pneumothorax > 10 mm, immediate, simple, manual aspiration was performed. Ipsilateral opposite-side aspiration was performed when simple aspiration failed.

Results: Among 129 CT image-guided biopsies, pneumothorax was detected by CT scan in 54 (42%); 51 (39%) were detected during the biopsy. Delayed pneumothorax occurred in two patients (1.55%). Manual aspiration to treat pneumothorax was performed in 27 of 129 procedures (21%). Simple aspiration was successful in 20 of these 27 cases (74%). Ipsilateral opposite-side aspiration was accomplished in the remaining seven cases (26%) and was successful in six cases (86%). Two of 129 procedures (1.55%) required chest tube placement.

Conclusions: Immediate, simple, percutaneous aspiration of iatrogenic pneumothorax was successful in 74% of patients needing treatment. Our proposed new method of ipsilateral opposite-side aspiration offers a solution for patients who remain with resistant pneumothorax after simple aspiration.