Complications

• Pneumothorax:
  Pneumothorax has been noted in 14-57% of patients. It should not come as a surprise to see such a high incidence of pneumothorax. In my opinion, it is surprising why it is not 100%. We are puncturing the visceral pleura. Leakage of air into the pleural space should be expected. I consider pneumothorax as: immediate and delayed; and, symptomatic and asymptomatic. Symptomatic pneumothorax requiring evacuation occurs in approximately 10% of patients. Most of the symptomatic pneumothoraxes occur immediately following the biopsy.

• Hemorrhagic:
  • Hemoptysis: Hemoptysis is the second most important complication of the procedure and has been reported to occur in 3-10% of patients. This complication is very alarming to both the patient and physician. Fortunately, the bleeding stops spontaneously. The pulmonary vascular bed is a low pressure system and this accounts for the benign nature of bleeding.

  • Hemothorax: Hemothorax is rare and is secondary to oozing of blood from the pleural puncture. The neurovascular bundle is usually not injured. Unlike pleural biopsy, there is no hooking maneuver that threatens this serious complication.

  Other hemorrhagic complications include pulmonary hemorrhage, mediastinal hemorrhage and hemopericardium.

• Other Rare Complications:
  • Seeding of tumor: Seeding of tumor at the puncture site has been occasionally reported, but is rare. It is for this reason that I prefer not to do needle aspiration biopsy in operable coin lesions.

  • Air embolism: Air embolism resulting in CVA has been reported. I have encountered this complication once. Confirmation of this complication can be done by the demonstration of air in upright skull x-rays. Mobilize the air column out of the brain by positioning the head down and hasten the absorption by allowing the patient to breath 100% oxygen. If the patient should develop acute onset of a neurological problem, proceed with therapy immediately. Do not wait for confirmation studies.

  • Mediastinal widening: Hemorrhagic complications in the mediastinum can cause of widening of the mediastinum. However, this complication is rare.

  • Cardiac tamponade: Cardiac tamponade has been reported in one patient following needle aspiration biopsy.

  Subcutaneous emphysema, infection, myocardial infarction, transient hypotension, death, chest pain and pleurisy are other rare possible complications.