Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried ou...Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% (91/281) and bleeding 34.5% (97/281). The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.展开更多
BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical...BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.展开更多
Background Computed tomography （CT）-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and ...Background Computed tomography （CT）-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population. Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure （pneumothorax and bleeding） were extracted. Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions （63.0%） and 322 benign lesions （31.8%）. Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%. Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.展开更多
Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis.Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and sq...Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis.Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and squamous cell components.We report the case of a 57-year-old male smoker who was admitted to the Emergency Room with skull and neck tumefactions,confusion and deteriorated general condition.The complementary study in the ER revealed severe hypercalcaemia(19.8 mg/dL),leukocytosis(18.7×10^(9)/L)and extensive osteolytic lesions of the skull on cranioencephalic computer tomography(CT).The patient was stabilized and admitted.Thoracoabdominopelvic CT showed lung parenchyma consolidation with necrotic areas,supra and infradiaphragmatic adenopathies and scattered osteolytic lesions.Percutaneous lymph node biopsy was consistent with metastasis of adenosquamous lung carcinoma.The patients’clinical situation evolved unfavourably after hospital-acquired infection.This case is characterized by a rare presentation of advanced stage adenosquamous lung carcinoma with scattered osteolytic lesions and severe hypercalcaemia-leukocytosis syndrome,an underrecognized marker of poor prognosis.展开更多
目的:探讨初次经皮肺穿刺活检过程中因气胸而活检失败,使用单腔深静脉管抽气后再行活检的安全性和可行性。方法:2017年8月至2021年8月452例患者行CT引导下肺穿刺活检,其中12例因出现气胸而活检失败,使用单腔深静脉管置入抽气并再次行肺...目的:探讨初次经皮肺穿刺活检过程中因气胸而活检失败,使用单腔深静脉管抽气后再行活检的安全性和可行性。方法:2017年8月至2021年8月452例患者行CT引导下肺穿刺活检,其中12例因出现气胸而活检失败,使用单腔深静脉管置入抽气并再次行肺活检。回顾性分析12例患者的病例资料,记录肺内病灶的大小、距离胸膜的距离、病灶在肺叶的位置、有无肺气肿、有无成功获得组织、有无明确的病理结果、有无肺内出血等并发症。结果:12例肺病灶直径为1.5~3.5 cm, 3例距离胸膜较近,平均距离为1.2 cm, 9例距离胸膜较远,平均距离为5.5 cm;8例病灶位于肺下叶,2例位于右肺中叶,2例位于右肺上叶,4例患者有肺气肿;12例患者再次活检后均成功取到组织并有明确的病理结果。活检完成后CT复查有4例出现少量渗出性改变,其中2例少量咯血,均经保守治疗后好转。1例合并肺气肿患者术后1 h出现大量气胸,行胸腔闭式引流后明显缓解。所有患者均未出现胸腔积液或其他严重并发症。结论:初次经皮肺穿刺活检过程中因气胸而活检失败,使用单腔深静脉管抽气后再次行肺活检安全、有效,值得临床推广应用。展开更多
文摘Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% (91/281) and bleeding 34.5% (97/281). The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
基金Supported by Natural Science Foundation of Liaoning Province,No.2021-MS-287。
文摘BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.
文摘Background Computed tomography （CT）-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population. Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure （pneumothorax and bleeding） were extracted. Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions （63.0%） and 322 benign lesions （31.8%）. Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%. Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.
文摘Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis.Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and squamous cell components.We report the case of a 57-year-old male smoker who was admitted to the Emergency Room with skull and neck tumefactions,confusion and deteriorated general condition.The complementary study in the ER revealed severe hypercalcaemia(19.8 mg/dL),leukocytosis(18.7×10^(9)/L)and extensive osteolytic lesions of the skull on cranioencephalic computer tomography(CT).The patient was stabilized and admitted.Thoracoabdominopelvic CT showed lung parenchyma consolidation with necrotic areas,supra and infradiaphragmatic adenopathies and scattered osteolytic lesions.Percutaneous lymph node biopsy was consistent with metastasis of adenosquamous lung carcinoma.The patients’clinical situation evolved unfavourably after hospital-acquired infection.This case is characterized by a rare presentation of advanced stage adenosquamous lung carcinoma with scattered osteolytic lesions and severe hypercalcaemia-leukocytosis syndrome,an underrecognized marker of poor prognosis.
文摘目的:探讨初次经皮肺穿刺活检过程中因气胸而活检失败,使用单腔深静脉管抽气后再行活检的安全性和可行性。方法:2017年8月至2021年8月452例患者行CT引导下肺穿刺活检,其中12例因出现气胸而活检失败,使用单腔深静脉管置入抽气并再次行肺活检。回顾性分析12例患者的病例资料,记录肺内病灶的大小、距离胸膜的距离、病灶在肺叶的位置、有无肺气肿、有无成功获得组织、有无明确的病理结果、有无肺内出血等并发症。结果:12例肺病灶直径为1.5~3.5 cm, 3例距离胸膜较近,平均距离为1.2 cm, 9例距离胸膜较远,平均距离为5.5 cm;8例病灶位于肺下叶,2例位于右肺中叶,2例位于右肺上叶,4例患者有肺气肿;12例患者再次活检后均成功取到组织并有明确的病理结果。活检完成后CT复查有4例出现少量渗出性改变,其中2例少量咯血,均经保守治疗后好转。1例合并肺气肿患者术后1 h出现大量气胸,行胸腔闭式引流后明显缓解。所有患者均未出现胸腔积液或其他严重并发症。结论:初次经皮肺穿刺活检过程中因气胸而活检失败,使用单腔深静脉管抽气后再次行肺活检安全、有效,值得临床推广应用。
