Iatrogenic pneumothorax after CT-guided lung biopsy

INTRODUCTION. CT-guided lung biopsy is an essential diagnostic tool for evaluating pulmonary infiltrates, but iatrogenic pneumothorax (PTX) is a frequent complication. Evidence regarding risk factors and management strategies for post-biopsy PTX is limited, and no specific guidelines exist. METHODS. We conducted a retrospective observational study including 267 patients who underwent CT-guided lung biopsy at Bispebjerg Hospital, Denmark, from 1 January to 30 June 2024. Data were collected on age, sex, smoking status, lung function, lesion location, distance to pleura and final diagnosis. The primary outcome was PTX within 72 hours after biopsy. The secondary outcome was the need for chest tube drainage among those with PTX. RESULTS. PTX occurred in 80 patients (30%). Those with PTX were more often male (52.5% versus 36.4%, p = 0.02), and male sex remained an independent predictor in multivariable analysis (OR = 1.93, 95% CI: 1.13-3.30). No associations were found for age, smoking status, lesion location, forced expiratory volume in the first second or distance to pleura. Seventeen patients (21%) with PTX required chest tube drainage. Lesion distance to pleura was significantly greater in the drainage group (44 mm versus 28 mm, p = 0.012) but did not differ between patients with and without PTX (31 mm versus 29 mm, p = 0.329). CONCLUSIONS. Iatrogenic PTX is a common complication of CT-guided lung biopsy. Male sex predicts PTX, whereas lesion depth predicts need for drainage. These findings support risk stratification and careful procedural planning to reduce the risk of iatrogenic PTX. FUNDING. None. TRIAL REGISTRATION. Not relevant.