Bilgisayarlı Tomografi Eşliğinde Transtorasik İnce İğne Aspirasyon Biyopsilerinde Pnömotoraks Risk Faktörlerinin Değerlendirilmesi

Abstract

Bu çalışmada, perkütan transtorasik akciğer biyopsi (PTAB) işlemi yapılan hastalarda pnömotoraks oranlarımızı ve pnömotoraks ile ilişkili risk faktörlerinin değerlendirilmesini amaçladık. Kliniğimizde yapılan 754 PTAB işlemine ait radyolojik görüntüler, raporları ve patoloji sonuçları retrospektif olarak incelendi. Pnömotoraks ve pulmoner hemoraji (PH) insidansı ve PH tipleri belirlendi. Biyopsi ilişkili pnömotoraks 143 hastada (%42,56) saptandı. Bu hastaların 130'unda (%90,91) ek tedavi gerekmezken, 13'ünde (%9,09) kateter drenajı uygulandı. Hastaların 153’ünde (%45,54) PH olup 124 hastada (%36,91) tip 1 (trakt hemorajisi), 29 hastada (%8,63) tip 2 (perilezyon hemorajisi) hemoraji mevcuttu. Amfizem varlığı, plevra-lezyon mesafesinin artması, plevra-cilt mesafesinin azalması, işlem sırasında iğne ile fissür geçilmesi, lezyonun perifissürel yerleşimli olması pnömotoraks riskini artıran faktörler olarak bulundu (sırasıyla p<0,001, p<0,001, p=0,007, p=0,017, p= 0,034). PH varlığı ve tipi ile pnömotoraks sıklığı arasında ilişki saptanmadı. Ancak trakt hemorajisinin, pnömotoraks gelişen hastalarda göğüs tüpü yerleştirilmesi için koruyucu faktör olduğu görüldü. PTAB akciğer kitlelerinin tanısında kabul edilebilir komplikasyon oranlarıyla güvenli ve etkili bir yöntemdir. PTAB’ye sekonder gelişen trakt hemorajisi, total pnömotoraks oranını azaltmasa da, kateterizasyon ihtiyacını minimize etmektedir.

Keywords

• Akciğer
• Biyopsi
• İnce-İğne aspirasyon
• Pnömotoraks

Evaluation of Pneumothorax Risk Factors in Computed Tomography-Guided Transthoracic Fine Needle Aspiration Biopsies

Abstract

In this study, we aimed to evaluate our pneumothorax rates and risk factors associated with pneumothorax in patients who underwent percutaneous transthoracic lung biopsy (PTAB). Radiological images, reports, and pathology results of 754 PTAB procedures performed in our clinic were reviewed retrospectively. The incidence of pneumothorax and pulmonary hemorrhage (PH) and PH types were determined. Biopsy-associated pneumothorax was detected in 143 patients (42.56%). Additional treatment was not required in 130 (90.91%) of these patients, while catheter drainage was performed in 13 (9.09%) patients. PH occurred in 153 (45.54%) patients, 124 (36.91%) had type 1 (tract hemorrhage) and 29 (8.63%) had type 2 (perilesional hemorrhage) hemorrhage. The presence of emphysema, increased pleural lesion distance, decreased pleural skin distance, passing through fissure with a needle during the procedure, and perifissurel localization of the lesion were found to increase the risk of pneumothorax (p<0.001, p<0.001, p=0.007, p=0.017, p= 0.034, respectively). The presence and type of PH did not affect the frequency of pneumothorax. However, tract hemorrhage was a protective factor for chest tube insertion in patients who developed pneumothorax. PTAB is a safe and effective method with acceptable complication rates in the diagnosis of lung masses. Although tract hemorrhage secondary to PTAB does not reduce the overall pneumothorax rate, it minimizes chest tube insertion.

Keywords

• Lung
• Biopsy
• Fine-Needle Aspiration
• Pneumothorax

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