Effect of needle aspiration for treating moderate to severe non-tension pneumothorax after PCNB

Introduction Although percutaneous needle biopsy (PCNB) is useful and widely used technique for assessment of parenchymal lung diseases, pneumothorax occurs frequently and sometimes requires chest tube drainage. This study aimed to evaluate the effect and safety of simple needle aspiration for treating moderate to severe non-tension pneumothorax after PCNB. Method As a prospective single center pilot study, we enrolled the subjects who had a documented non-tension pneumothorax in chest radiograph after PCNB measuring over 25% in size by Collin’s method. Patients with mild pneumothorax less than 25% in size, moderate to severe underlying lung disease, recurrent pneumothorax, and severe cardiovascular comorbidities were excluded. Simple needle aspirations were performed through the second intercostal space on the midclavicular line using a 22-gauge angio-catheter following bedside ultrasonography for the confirmation of the pneumothorax. We assessed the change in the size of pneumothorax by chest radiographs taken 1 hour and 12 hours later and monitored for procedure-related complications. Result Eight patients with moderate to severe pneumothorax after PCNB were screened between May and November 2021; moreover, seven patients fulfilling the inclusion criteria were enrolled. Needle aspirations were successful in all seven patients without complications. The pneumothoraxes were improved after needle aspirations in five of the seven patients; a chest tube drainage was not required. Nonetheless, the pneumothorax persisted with a similar size after needle aspiration in two patients and was subsequently resolved following chest tube drainage. The mean hospital stay for the patients with needle aspiration (3.8 days) was shorter than that for the patient with chest tube drainage (8 days). Conclusion Needle aspiration is useful and safe procedure to treat moderate to severe non-tension pneumothorax after PCNB. In addition, needle aspiration for post-PCNB pneumothorax might be effective in reducing chest tube insertion and hospitalization; still, further larger prospective clinical trial is needed to evaluate this.