The absolute contraindication for a pleural biopsy is the presence of an uncorrectable coagulation defect. The relative contraindications are as follows:
I did perform a dry pleural biopsy eventually on that patient without any complications. Incidentally, the patient had a caseating granuloma in the pleura. In general, you should not attempt a pleural biopsy if there is no fluid. If there is a strong indication, it is best left to an physician with extensive past experience. You mainly have to judge by the feel of the needle as to its locale withot the benefit of fluid.
If there is a strong indication for a pleural biopsy without a reasonable alternative, you may want to consider the biopsy following correction of the coagulation defect.
The most common situation is a patient on coumadin. I discontinue the coumadin and switch to heparin. On the day of the biopsy, heparin should be stopped four hours prior to the procedure. You can resume anticoagulation four hours after the biopsy, assuming all is well.