OUTPATIENT TREATMENT OF IATROGENIC PNEUMOTHORAX AFTER NEEDLE-BIOPSY

PURPOSE: To evaluate prospectively the feasibility of treating iatroge nic pneumothorax after fine-needle aspiration biopsy (FNAB) of the lun g with short-term placement of a small-caliber chest tube and to deter mine whether a 1-hour clamping trial is adequate to identify patients with persistent air leak. MATERIALS AND METHODS: All patients undergoi ng FNAB of lung masses over a 28-month period were entered into the st udy. Patients with symptomatic, enlarging, or greater than 30% pneumot horax were treated with an 8-F chest tube, After 2 hours, the chest tu be was clamped, and if the lung remained expanded for an additional ho ur, the chest tube was removed and the patients were discharged after a brief observation period. Patients were followed up by telephone aft er 24 hours. RESULTS: Three hundred fifteen patients underwent FNAB of the lung. Sixty-eight patients (22%) developed a pneumothorax. Chest tubes were placed in 14 patients (4%): Six patients (2%) required admi ssion to the hospital (four for air leaks), and the other eight patien ts were treated successfully as outpatients, with removal of the chest tube before discharge the day of FNAB. CONCLUSION: Patients who devel op clinically important pneumothorax after FNAB can be safely treated with short-term, small-caliber chest tubes and require hospital admiss ion only if they demonstrate evidence of continued air leak.