Aspiration of a large pneumothorax resulting from transthoracic needle biopsy

PURPOSE: To determine whether simple aspiration of air from the pleural space could obviate chest tube placement in patients with a large pneumothorax after transthoracic needle biopsy. MATERIALS AND METHODS: Seventeen patients, who developed a large pneumothorax (> 30%) during computed tomographic (CT)-guided transthoracic needle biopsy and otherwise would have required chest tube placement, underwent percutaneous aspiration of the pneumothorax while on the CT scanner table. Air was aspirated from the pleural space by using an 18-gauge intravenous catheter attached to a three- way stopcock and a 50-mL syringe. The patients were positioned with the puncture site down after aspiration of the pneumothoraces and oxygen was administered both during and after the procedure. RESULTS: The pneumothorax was almost completely aspirated in all 17 patients. Twelve (70%) patients did not require chest tube placement. Follow-up chest radiographs obtained 2 and 4 hours after the procedure revealed complete or almost complete resolution of the pneumothorax in eight (47%) patients and partial recurrence of a small, stable pneumothorax in four (24%) patients. The remaining five (29%) patients had recurrence of their pneumothorax, which ultimately required chest tube placement. CONCLUSION: Percutaneous catheter aspiration of a large biopsy-induced pneumothorax is safe and easy to perform and may obviate chest tube placement.