Variable Presentations of Thoracic Biopsy Related Hemothorax

Computed tomography (CT) guided percutaneous biopsy is a frequently performed procedure to establish a pathologic diagnosis in thoracic disease. While the most frequent complication of percutaneous chest biopsy is pneumothorax, hemothorax is a rare but potentially fatal complication. The purpose of this study is to assess the risk of post biopsy hemothorax, its associated consequences, and describe reasonable precautions for minimizing this risk. A retrospective chart review of all percutaneous thoracic biopsies completed at two affiliated institutions from January 1, 2006 to June 30, 2011 was performed to evaluate complications rates. A total of 830 biopsies were performed over a five and a half year period. The overall complication rate was 34.1%, with the majority being pneumothorax (32.5%). A total of 4 confirmed hemothoraces (0.5%) occurred. The onset of hemothorax was variable with three cases occurring immediately post-procedure while a fourth occurred 15 hours later. Treatments included observation, tube thoracostomy, and thoracotomy. In conclusion, hemothorax is a rare but serious complication of percutaneous biopsy which may be more common than previously reported.