Complications

The reported complications of pleural biopsy are:

  1. Hemothorax:
    Accidental injury to the neurovascular bundle may result in arterial bleeding which would require a thoracotomy to correct. It was stressed throughout the procedure never to direct the biopsy hook upwards along the inferior margin of the rib.

    Of course, a pleural biopsy is contraindicated when there is a coagulation defect either secondary to disease process or use of anticoagulants. The granulation tissue tends to bleed and I strongly advise against pleural biopsy in patients with empyema. I am also very scared of uremic patients. They tend to bleed in spite of normal PT, PTT and platelet counts. This may possibly be due to platelet function impairment.

    If proper care is taken in avoiding patients with an increased risk of bleeding, this complication is rare. I have encountered this complication twice. Once in an uremic patient and once in a patient with myelofibrosis and empyema.

  2. Empyema:
    Empyema could complicate the procedure. I have not come across this complication yet. If you follow strict sterile surgical techniques, this complication should not occur.
  3. Pneumothorax:
    A pneumothorax can complicate the procedure. Two types of pneumothorax can occur in this situation:
  4. Seeding of Tumor:
    Tumor seeding at the site of the biopsy has been reported. Fortunately, it is rare and inconsequential. Since we are dealing with a patient with metastatic disease to start with, this complication would not alter the outcome. However, this complication occurs frequently in patients with mesothelioma and they are distressing to the patient.

    Unfortunately, the diagnosis by pleural biopsy is difficult in patients with mesothelioma. This results in multiple biopsy attempts. I have seen this complication twice and the tumor growth along the track of biopsy were massive, disfiguring and painful.

    Due to the inability of making a definite diagnosis of mesothelioma by pleural biopsy and this distressing complication, I resort to performing an open or thoracoscopic biopsy whenever my working diagnosis is mesothelioma.

  5. Extravasation:
    Extravasation of pleural fluid can occur along tissue planes and the patient can develop massive swelling of the back, abdominal wall and genitals. This complication occurs in patients with massive effusion under significant pressure.

    You can avoid this complication by evacuating some of the fluid following the biopsy and applying a pressure bandage. The fluid will be absorbed spontaneously. The problem is mainly cosmetic. The bandage can soak through and soil the patient's clothing. You may have to repeatedly change the dressing. Remember that the biopsy process leaves a sizeable hole in the pleura.