Pneumothorax After Transbronchial Biopsy or Fine Needle Aspiration: Can it be Predicted? A Prospective Study of 94 Cases

Introduction: Many institutions routinely perform chest radiographs after transbronchial biopsy (TBB) or transbronchial fine needle aspiration (TBFNA). This study investigates whether chest radiographs are required in all cases or if physicians are able to predict a higher risk for pneumothorax in selected procedures. Materials and Methods: Over a period of 24 months, all consecutive diagnostic procedures involving TBB and TBFNA were prospectively investigated. Four operators (2 consultants, 2 trainees) were involved. Risk for pneumothorax was rated immediately after bronchoscopy as high, intermediate, or low. Four hours after the procedure, symptoms were assessed and a dorso-ventral chest x-ray was made. Results: Overall, 94 patients underwent TBB or TBFNA. Seventy-six bronchoscopies were rated as low, 18 as intermediate, and none as high risk. Two pneumothoraces (2.1%) occurred, 1 in a procedure rated as low and 1 in a TBB rated as intermediate risk by the operator. One pneumothorax required further intervention, this patient also suffered from dyspnea 4 hours after bronchoscopy. The other pneumothorax resolved spontaneously. Discussion: In this case series, the overall rate of pneumothorax was low. However, the operators were not capable to predict the occurrence of a pneumothorax immediately after the procedure. Nonetheless, the combination of low or intermediate risk and absence of symptoms 4 hours after the procedure may reliably predict an uncomplicated outcome.