Curved Needles in CT-Guided Fine Needle Biopsies of Pulmonary Lesions: an Ability to Reduce the Incidence of Pneumothorax

Effect of puncture sites on pneumothorax after lung CT-guided biopsy

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.

Use of a steerable needle for CT-guided nerve plexus blockade

PURPOSE

Demonstrate the use of a new steerable needle for CT-guided neural plexus blockade to avoid traversing the kidneys.

MATERIALS AND METHODS

Retrospective evaluation of 23 consecutive CT-guided neural plexus blockade procedures in which a new steerable needle was used in the last 13 and compared with the prior 10 procedures in which a standard needle was used.

RESULTS

Use of the steerable needle was beneficial to reach the target area without traversing a kidney or other organs in 6/13 (46%) procedures; in the other 7 procedures there was no benefit. A kidney was traversed in 0/13 procedures performed with the steerable needle. In contrast, a kidney was traversed in 4/10 (40%) procedures using a standard needle (P = 0.02). There was no significant difference in clinical benefit (P = 1.00) or complications (P = 0.56) between procedures using the steerable needle versus a standard needle. Three complications were observed (1 major and 2 minor) felt to be related to the injection and not the needle type.

CONCLUSIONS

The utility of a steerable 21-gauge needle during neural plexus blockades was found to allow for avoidance of the kidneys when compared to a standard (non-steerable) needle. Interventional radiologists may find this needle and its future iterations useful for neural blockades, as well as other procedures, when intervening structures need to be avoided.

LEVEL OF EVIDENCE

Level 3, Non-randomized controlled cohort.