Chest
Volume 129, Issue 6, June 2006, Pages 1561-1564
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Original Research
Is Routine Chest Radiography After Transbronchial Biopsy Necessary?: A Prospective Study of 350 Cases

https://doi.org/10.1378/chest.129.6.1561Get rights and content

Background and study objective

Pneumothorax following flexible bronchoscopy (FB) with transbronchial biopsy (TBB) occurs in 1 to 6% of cases. Routine chest radiography (CXR) following TBB is therefore requested by most pulmonologists in an attempt to detect complications, particularly pneumothorax. The objective of this study was to determine if routine CXR after bronchoscopy and TBB is necessary.

Patients and method

The study group included 350 consecutive patients who underwent FB with TBB at our institution between December 2001 and January 2004. Routine CXR was performed up to 2 h after the procedure in all cases. Additionally, the following information was recorded in all patients: sex, age, immune status, indication for bronchoscopy, total number of biopsies done, segment sampled, pulse oxygen saturation, and development of symptoms suggestive of pneumothorax.

Results

Pneumothorax was diagnosed radiologically in 10 patients (2.9%). Seven patients had symptoms strongly suggestive of pneumothorax prior to CXR, including four patients with large (> 10%) pneumothorax. The other three patients were asymptomatic, with only minimal pneumothorax (≤ 10%), which resolved completely 24 to 48 h later.

Conclusions

We conclude that routine CXR after bronchoscopy with TBB is necessary only in patients with symptoms suggestive of pneumothorax. In asymptomatic patients, pneumothorax is rare and usually small, so routine CXR is not necessary in this category of patients.

Section snippets

Materials and Methods

All consecutive patients referred for FB with fluoroscopically guided TBB at the Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel, between December 2001 and January 2004 were enrolled in the study. FB was performed with midazolam, 1–2 mg IV as needed, and fentanyl, 0.5 mg, sedation. Each patient underwent CXR within 2 h after the procedure, in accordance with our departmental policy. The CXR films were examined by radiologists blinded to the study protocol and the patient’s clinical

Results

Of 1,227 consecutive bronchoscopies performed in our institute between December 2001 and January 2004, 350 procedures (29.5%) included TBB. Indications for FB with TBB were suspected cancer (n = 96, 27.4%); lung or heart-lung transplantation (n = 91, 26%); persistent infiltrates (n = 63, 18%); interstitial lung disease (n = 42, 12%); suspected sarcoidosis (n = 33, 9.4%); suspected tuberculosis (n = 14, 4%); and others (n = 11, 3.2%). One hundred twenty-two patients (34.8%) were considered

Discussion

The present study is the largest prospective investigation examining the role of routine CXR following FB with TBB. In this study, the large majority of patients (97%) had no radiographic pneumothorax and no clinical symptoms. The four patients found by CXR to have large pneumothoraces requiring treatment were all symptomatic, and physicians suspected pneumothorax before CXR in all of them. Only three patients who were asymptomatic had pneumothorax, but the pneumothoraces were small (≤ 10%) and

ACKNOWLEDGMENT

The authors thanks Dr. T. K. Aldrich, Chief, Unified Pulmonary Division of the Albert Einstein College of Medicine, Bronx, NY, for critical review of this article.

References (8)

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No financial support was received for this study.

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