Effect of needle aspiration for treatment of moderate to severe non-tension pneumothorax after transthoracic needle biopsy

Background: Transthoracic needle biopsy (TTNB) is a widely used technique for assessing parenchymal lung diseases. However, pneumothorax often occurs after TTNB and may sometimes require chest tube drainage. We aimed to evaluate the efficacy and safety of simple needle aspiration for treating moderate to severe non-tension pneumothorax following TTNB. Methods: This prospective, single-center pilot study conducted between May and November 2021. Participants with non-tension pneumothorax measuring >25% in size on radiography after TTNB were included. Simple needle aspirations were performed through the second intercostal space on the midclavicular line using a 16-gauge angio-catheter. Changes in the size of the pneumothorax were assessed using chest radiographs at 1 and 12 h postprocedure. Results: Seven patients with moderate to severe pneumothorax after TTNB were included. Needle aspirations were successful in all patients without complications. Pneumothoraces improved in five patients after needle aspiration, eliminating the need for chest tube drainage. However, in two patients, pneumothorax of a similar size persisted after needle aspiration and was subsequently resolved with chest tube drainage. The mean duration of hospital stay for the patients with successful needle aspiration was shorter (3.8 d) compared to those requiring chest tube drainage after failed needle aspiration (8 d). Two patients who underwent chest tube drainage reported pain [Numeric Rating Scale (NRS) 4] and received analgesic drugs, while no pain (NRS 0) was reported after needle aspiration. Conclusions: Needle aspiration is a safe and effective procedure for the treatment of moderate to severe non-tension pneumothorax following TTNB. It may reduce the need for chest tube insertion, shorten hospitalization duration, and decrease procedure-related pain and analgesic use.