A Retrospective Multi-Site Academic Center Analysis of Pneumothorax and Associated Risk Factors after CT-Guided Percutaneous Lung Biopsy.

PURPOSE: To assess the risk factors, incidence and significance of pneumothorax in patients undergoing CT-guided lung biopsy. METHODS: Patients who underwent a CT-guided lung biopsy between August 10, 2010 and September 19, 2016 were retrospectively identified. Imaging was assessed for immediate and delayed pneumothorax. Records were reviewed for presence of risk factors and the frequency of complications requiring chest tube placement. 604 patients were identified. Patients who underwent chest wall biopsy (39) or had incomplete data (9) were excluded. RESULTS: Of 556 patients (average age 66 years, 50.2% women) 26.3% (146/556) had an immediate pneumothorax and 2.7% (15/556) required chest tube placement. 297/410 patients without pneumothorax had a delayed chest X-ray. Pneumothorax developed in 1% (3/297); one patient required chest tube placement. Pneumothorax risk was associated with smaller lesion sizes (OR 0.998; 95% CI (0.997, 0.999); [p = 0.002]) and longer intrapulmonary needle traversal (OR 1.055; 95% CI (1.033, 1.077); [p < 0.001]). Previous ipsilateral lung surgery (OR 0.12; 95% CI (0.031, 0.468); [p = 0.002]) and longer needle traversal through subcutaneous tissue (OR 0.976; 95% CI (0.96, 0.992); [p = 0.0034]) were protective of pneumothorax. History of lung cancer, biopsy technique, and smoking history were not significantly associated with pneumothorax risk. CONCLUSION: Delayed pneumothorax after CT-guided lung biopsy is rare, developing in 1% of our cohort. Pneumothorax is associated with smaller lesion size and longer intrapulmonary needle traversal. Previous ipsilateral lung surgery and longer needle traversal through subcutaneous tissues are protective of pneumothorax. Stratifying patients based on pneumothorax risk may safely obviate standard post-biopsy delayed chest radiographs.

Umbilical hernia simulating recurrent carcinoid on octreoscan.

Physiologic bowel activity on In-111 octreotide imaging is commonly seen. However, on occasion, normal bowel activity may mimic lesions in the abdomen, which can be very difficult to differentiate, particularly after surgical intervention. We report a case of focal bowel activity simulating a lesion in a patient who had an In-111 octreotide scan (Octreoscan), postoperatively, looking for recurrent carcinoid. SPECT/CT demonstrated that the uptake was localized in the anterior abdomen, and corresponded to a loop of bowel within a ventral hernia at the site of surgical incision. The correlation with CT as well as the precise localization made possible by the fusion images helped avoid misinterpretation of this finding as possible recurrent carcinoid.

Online survey of radiologic ordering practices by pediatric trainees.

OBJECTIVE: The ACR has developed appropriateness criteria to ensure that patients are receiving appropriate imaging studies. The purpose of this study was to compare the imaging ordering practices of pediatric residents in specific clinical scenarios with the ACR Appropriateness Criteria. MATERIALS AND METHODS: A multiple-choice questionnaire was created using 10 clinical scenarios excerpted from the ACR Appropriateness Criteria. The questionnaire was sent to 69 pediatric residents (postgraduate years 1-3) at Children's Hospital of New York at Columbia University Medical Center (CHONY) and then to 75 pediatric residents at The Children's Hospital at Montefiore Medical Center (CHAM). The responses were compared with the ACR Appropriateness Criteria. RESULTS: Seventy-five and 69 pediatric residents from the CHAM and CHONY, respectively, were invited to participate in the survey. Thirty-nine individual responses (52%) were received from CHAM, and 41 (59%) were received from CHONY. A total of 27 responses were received from first-year residents, 28 from second-year residents, and 25 from third-year residents. The average number of questions answered incorrectly by first-year residents was 4.1, by second-year residents was 4.4, and by third-year residents was 4.5. CONCLUSIONS: This study demonstrates that residents appreciate the value of an imaging workup, but these examinations are often ordered without the consultation of a radiologist. The decision each resident makes reflects individual training. To improve residents' ability to make decisions regarding imaging examinations, radiologists must educate pediatric residents with uniform case-based and didactic sessions.

Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT.

BACKGROUND: Pacemakers and implantable cardiac defibrillators (ICDs) are widely used for the management of cardiac arrhythmias and congestive heart failure (CHF). Acute implantation complication rates range from 3% to 7%. The aim of this study is to describe the incidence of lead perforation on computed tomography (CT), and correlate these findings with electrophysiologic data. METHODS: Images of 100 consecutive patients with permanent pacemakers (n = 72) or ICDs (n = 28) who underwent multidetector CTs of the chest were identified. Cases were reviewed by 2 cardiothoracic radiologists, and a third if there was disagreement. Each CT was reviewed for device and fixation type, tip position, and presence of pericardial effusion. Results were correlated with lead impedance and pacing threshold, when available [79% (79/100)]. A cardiac electrophysiologist interpreted device data. RESULTS: All 100 patients had right ventricular leads (58 passive, 42 active) and 61 had right atrial leads (12 passive, 49 active). 15% (15/100) of patients had a lead perforation. Perforation rates were 15% (9/61) for atrial and 6% (6/100) for ventricular leads (P < 0.05, chi square). Four of 28 (14%) right ventricular ICD leads and 2 of 72 (3%)right ventricular pacemaker leads were perforated (P < 0.05, chi square). 12% (6/49) of active right atrial leads, and 25% (3/12) of passive right atrial leads perforated (P = NS, chi square). 7% (3/42) of active right ventricular leads, and 5% (3/58) of passive ventricular leads perforated (P = NS, chi square). Electrophysiologic parameters did not differ significantly between perforated and nonperforated leads. CONCLUSION: Asymptomatic perforation is a common phenomenon and rarely resulting in electrophysiologic consequences. Atrial leads perforated more frequently than ventricular leads, and ventricular ICD leads perforated more frequently than ventricular pacemaker leads.