In CT-guided percutaneous biopsy of a lung lesion, which complication is MOST common and is related to the distance the needle traverses through aerated lung?

• A Haemothorax due to intercostal artery puncture
• B Air embolism due to communication with pulmonary veins
• C Tumour seeding along the needle track
• D Pneumothorax due to air leak from the visceral pleura puncture ✓

Explanation

Pneumothorax is the most common complication of CT-guided percutaneous lung biopsy, occurring in 15-25% of cases (with approximately 5-7% requiring chest tube drainage). Risk factors include: greater distance traversed through normal aerated lung to reach the target, emphysema or COPD (bullae, poor lung compliance), smaller lesion size (requiring deeper penetration), and lesion traversal of a fissure. The risk increases with number of needle passes. Air embolism is a rare but potentially fatal complication if systemic. Haemothorax occurs in ~2-5%. Needle track seeding is rare for lung biopsy. The risk-benefit ratio of diagnostic information versus pneumothorax risk must be considered for each patient.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.