A 55-year-old male smoker's CT chest shows a 28 mm spiculated mass in the right upper lobe with hilar lymphadenopathy and a pleural effusion. CT-guided biopsy is planned. Which lobe position on CT is the LEAST favourable for CT-guided percutaneous lung biopsy due to highest risk of pneumothorax?
- A Deep central lesion requiring traversal of two pleural surfaces and lung parenchyma ✓
- B Right lower lobe — posterior segment
- C Left upper lobe — apicoposterior segment
- D Right upper lobe — anterior segment close to the chest wall
Explanation
Factors that increase pneumothorax risk during CT-guided lung biopsy include: depth from pleura (lesion > 3 cm deep), traversal of multiple fissures, emphysematous lung adjacent to the path, patient with severe COPD (reduced lung compliance), and the needle crossing two pleural surfaces (e.g., going through an incomplete fissure or crossing the fissure to reach a lesion). A deep central lesion requiring traversal of the entire lung thickness poses the highest pneumothorax risk. Peripheral, subpleural lesions have the lowest risk. Emphysema significantly increases pneumothorax severity even when it occurs.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.