CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage?

PURPOSE: We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax. MATERIALS AND METHODS: We reviewed the CT images of 538 patients (364 males and 174 females, mean age 70 years, range 36-90 years) who underwent CT-guided TTFNA of pulmonary nodules between January 2008 and September 2013. The following CT findings were assessed: pulmonary hemorrhage (type 1, along the needle track; type 2, perilesional; low-grade, ≤6 mm; high-grade, >6 mm), pneumothorax, distance between the target nodule and the pleural surface, and emphysema. RESULTS: Pneumothorax occurred in 154 cases (28.6%) and pulmonary hemorrhage occurred in 144 cases (26.8%). The incidence of pneumothorax was lower in patients showing type 1 and high-grade pulmonary hemorrhage pattern. The incidence of pneumothorax in biopsies ≥30 mm from pleural surface was 26% (12/46) in cases showing this pattern, while it was 71.4% (30/42) when this pattern was not seen. Similarly, the incidence of pneumothorax in biopsies <30 mm from the pleural surface was 0% (0/28) in cases showing this hemorrhage pattern, while it was 19% (76/394) when this pattern was not seen. CONCLUSION: Pulmonary hemorrhage during TTFNA is a frequent event that protects against pneumothorax. A bleeding greater than 6 mm along the needle track is associated with lower incidence of pneumothorax, especially in biopsies deeper than 3 cm.

Occult large epiphyseal solitary plasmacytoma at multidetector row computer tomography detected by magnetic resonance imaging.

Myeloma or Kahler-Bozzolo disease represents around 1% of all malignant tumors and 10% of the haematological variety; it is a B-lymphocellular malignant neoplasia which originates from plasma cells that produce monoclonal immunoglobulin, infiltrating in and destroying the adjacent bone tissue. Myeloma may be distinguished at radiological imaging in four distinct types: single osseous lesions (solitary plasmacytoma), diffused skeletal effects (myelomatosis), diffused osteopenia and sclerosing myeloma. It is known that initial osteolysis may not be shown through radiographic examination or CT; the lysis only becomes evident when there is a bone loss of over 50%, usually in the presence of a > or = 0.5 cm focal lesion. We present here the clinical-radiological aspects of a solitary bone plasmacitoma (SBP) of the knee of a 35 year old male which was not evidenced at radiological examination or CT but was evident as a 3 cm focal alteration at MR. The lesion was confirmed by PET and the histological diagnosis was performed by a CT guided bioptic sample.