ABSTRACT
Background Pneumothorax is the most common complication of computed tomography (CT)-guided lung biopsy. The asymptomatic rate ranges from 17.5 to 72%. The symptomatic rate requiring chest tube insertion is 6 to 18%. Aims This article studies the role of management of postbiopsy pneumothoraces by needle aspiration and pigtail catheter insertion. Methods This was a prospective observational study conducted over 2 years. Postbiopsy and prior to withdrawing the coaxial cannula a CT data set was obtained to detect and quantify pneumothoraces as mild, moderate, and severe. In all asymptomatic cases of mild pneumothorax simple observation was done. In all asymptomatic cases of moderate pneumothorax, immediate needle aspiration was performed. In all symptomatic cases, cases with severe pneumothorax, and cases with progressively enlarging pneumothorax small caliber 6 to 8F pigtail catheters were inserted. Results Ninety-one cases had mild pneumothorax, 42 had moderate pneumothorax, and 18 had severe pneumothorax. In the 91 patients of mild pneumothorax only 1 (1%) patient showed increase in size of pneumothorax on follow-up requiring catheter insertion. In the 42 cases of moderate pneumothorax, which were managed by simple aspiration of pneumothorax, 4 (9.5%) cases showed increase in size of pneumothorax on follow-up. A total 23 cases required pigtail catheter insertion in our study. These constituted 15.2% of pneumothorax cases. The mean duration of catheterization in our study was 3.74 ± 1.09 days. Conclusion Majority of pneumothoraces are benign and do not require any intervention, just observation. Manual aspiration is an effective way of treating moderate pneumothoraces with success rate of 90%, thereby reducing the number of cases requiring catheter insertion; however, close observation is required as few cases may progress to severe pneumothorax and require pigtail insertion. Only a small percentage of biopsy cases (6.4%) require catheter insertion which is a safe and effective treatment.
ABSTRACT
Visceral artery pseudoaneurysms are potentially lethal lesions and tend to rupture in a high proportion of cases, thereby warranting an immediate and active intervention. We present our experience of splanchnic visceral artery pseudoaneurysms in a university hospital over a 5-year time interval with emphasis on etiology, clinical presentation, management (endovascular/surgical), and final outcome. This was a retrospective study in which we searched our image database for pseudoaneurysms of visceral arteries over a period of 5 years. The clinical and operative details were retrieved from the medical record section of our hospital. The lesions were analyzed for the vessel of origin, size, etiology, clinical features, mode of treatment, and outcome. Twenty-seven patients with pseudoaneurysms were encountered. Pancreatitis (8) was the most common cause, followed by previous surgery (7) and trauma (6). Fifteen were managed by the interventional radiology (IR) team, 6 by surgery, and in 6 no intervention was done. Technical and clinical success was achieved in all patients in the IR group with few minor complications. Surgery and no intervention carry a high mortality in such a setting (66 and 50%, respectively). Visceral pseudoaneurysms are potentially fatal lesions, commonly encountered after trauma, pancreatitis, surgeries, and interventional procedures. These lesions are easily salvageable by minimally invasive interventional techniques (endovascular embolotherapy), and surgeries carry a lot of morbidity and mortality in such cases and a prolonged hospital stay.
