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Incidence, Predictors and Treatment Outcomes of
Pneumothorax Following CT-guided Transthoracic Core
Needle Lung Biopsy at Ramathibodi Hospital
Panida Wannarat, Warawut Sukkasem, Tharintorn Treesit, Adisorn Plongmai*
Department of Diagnostic and Therapeutic, Radiology Faculty of Medicine, Ramathibodi Hospital, Mahidol
University
*Corresponding Author E-mail: joffiiz@gmail.com
Background: Abstract
Transthoracic needle lung biopsy is a well-established, minimally invasive procedure for
obtaining tissue samples to diagnose pulmonary lesions. However, pneumothorax remains
the most common complication and can be life-threatening. The reported incidence and
risk factors for pneumothorax vary widely across studies. This study aimed to determine
the incidence, predictors, and treatment outcomes of pneumothorax following CT-guided
transthoracic core needle lung biopsy at Ramathibodi Hospital.
Methods: We retrospectively analyzed data from 238 patients who underwent CT-guided transthoracic
core needle lung biopsy at Ramathibodi Hospital between January 2019 and December
2023. The incidence and treatment outcomes of pneumothorax and chest tube placement
were evaluated. Independent predictors of pneumothorax were identified using multivariate
analysis of variables related to patient demographics, lung lesions, and biopsy procedures.
Results: The incidence of pneumothorax was 54.2%, with the majority (98.5%) classified as small
pneumothorax. The only significant risk factor was smaller lesion size (≤ 2 cm), with a p-value
of 0.02 and an odds ratio of 1.92 (95% CI: 1.11–3.34). Most cases (99%) of pneumothorax
were successfully managed with conservative treatment. The treatment outcomes showed
100% resolution within 24 hours and complete improvement at the 2-week follow-up.
Conclusion: Pneumothorax following CT-guided lung biopsy is more likely in patients with smaller
lesion sizes (≤ 2 cm). Increased vigilance is recommended in such cases. However, the
majority of pneumothoraces are minor and do not require intervention.
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