Relationship between emphysema and risk of pneumothorax in percutaneous computed tomography-guided lung biopsy

Introduction: CT-guiaded transthoracic biopsy is one of he most commonly used methods for obtaining a reliable sample for the histopathological study of pulmonary nodules. Pneumothorax is highlighted as one of the most frequent complications.
Objective: To analyze the incidence of pneumothorax in lung biopsies and its relationship with emphysema. To assess whether there is a higher frequency of this complication in any of the steps of the process.
Method: A retrospective that includes percutaneous lung biopsy procedures performed between May 2021 and April 2023. The presence of emphysema and the relation of the lesion to the pleura were established as variables and so was the pneumothorax as a complication. The RR (95%CI) of pneumothorax was assessed according to the presence of emphysema and pleural contact.
Results: Among 70 cases, 27 (39%) showed signs of emphysema. Among cases with pneumothorax, 71% were on needle removal. Among patients with pneumothorax, 10 (71%) had emphysema (RR: 4.0; 95%CI: 1.4-11.4; p = 0.01) and nine of them (90%) were on needle removal. Of the pleural contact lesions, 2/34 developed pneumothorax (RR: 0.17; 95%CI: 0.04-0.69; p = 0.01).
Conclusions: We identified a significant relationship between emphysema and risk of pneumothorax. This was most frequently observed at needle removal and in punctures of lesions without pleural contact, which suggests that the parenchymal damage of emphysema prevents the entry orifice of the lung tissue from closing.