Zhu Jianbin, Qu Yaoming, Wang Xianlong, Jiang Chunxiu, Mo Jianhua, Xi Jiandong, Wen Zhibo
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Quant Imaging Med Surg. 2020 May;10(5):1008-1020. doi: 10.21037/qims-19-1024.
Pulmonary hemorrhage and hemoptysis are the second-most common and potentially life-threatening complications after pneumothorax following percutaneous computed tomography-guided transthoracic lung biopsy (PCTLB). Preventing hemorrhagic complications after PCTLB requires an accurate estimation of risk factors. This study investigated the risk factors associated with pulmonary hemorrhage and hemoptysis following PCTLB, and whether the ratio of main pulmonary artery diameter (mPAD) to ascending aorta diameter (mPAD/AAD ratio) is a risk factor.
We retrospectively analyzed 1,090 cases of PCTLB obtained from 1,050 patients using a core needle. The risk factors for overall pulmonary hemorrhage, higher-grade pulmonary hemorrhage, and hemoptysis were evaluated by multivariate analysis of patient characteristics, computed tomography (CT) imaging data including pulmonary artery diameter (mPAD) to ascending aorta diameter (mPAD/AAD) ratio, technical variables related to the biopsy, and pathologic findings.
Pulmonary hemorrhage occurred in 31.38% (342/1,090) of PCTLB cases, including lower-grade (24.4%, 266/1,090) and higher-grade hemorrhage (6.97%, 76/1,090). The incidence of hemoptysis was 3.03% (33/1,090). Multivariate analysis revealed significant associations between overall pulmonary hemorrhage and lesion location in the lower lobe, subsolid and smaller lesions, greater lesion depth, and lung metastases. For higher-grade pulmonary hemorrhage, an mPAD/AAD ratio >1, smaller lesions, greater lesion depth, emphysema, and lung metastases were risk factors. Risk factors for hemoptysis were history of hypertension and lower- and higher-grade pulmonary hemorrhage.
Pulmonary artery enlargement detected by CT (mPAD/AAD ratio >1) is independently associated with higher-grade pulmonary hemorrhage following PCTLB.
肺出血和咯血是经皮计算机断层扫描引导下经胸肺活检（PCTLB）后气胸第二常见且可能危及生命的并发症。预防PCTLB后的出血并发症需要准确评估危险因素。本研究调查了PCTLB后与肺出血和咯血相关的危险因素，以及主肺动脉直径（mPAD）与升主动脉直径之比（mPAD/AAD比值）是否为危险因素。
我们回顾性分析了1050例使用活检针获取的1090例PCTLB病例。通过对患者特征、计算机断层扫描（CT）成像数据（包括肺动脉直径（mPAD）与升主动脉直径（mPAD/AAD）比值）、与活检相关的技术变量以及病理结果进行多因素分析，评估总体肺出血、高级别肺出血和咯血的危险因素。
1090例PCTLB病例中，31.38%（342/1090）发生肺出血，包括低级别（24.4%，266/1090）和高级别出血（6.97%，76/1090）。咯血发生率为3.03%（33/1090）。多因素分析显示，总体肺出血与下叶病变位置、亚实性和较小病变、更大病变深度以及肺转移之间存在显著关联。对于高级别肺出血，mPAD/AAD比值>1、较小病变、更大病变深度、肺气肿和肺转移是危险因素。咯血的危险因素是高血压病史以及低级别和高级别肺出血。
CT检测到的肺动脉增宽（mPAD/AAD比值>1）与PCTLB后高级别肺出血独立相关。
