Timing of chest film follow-up after transthoracic needle aspiration

Transthoracic needle aspiration of pulmonary lesions is an extremely common procedure. Pneumothorax, the most common complication, is potentially life threatening. In an effort to determine the optimum time for obtaining chest radiographs to detect pneumothorax, all cases of pneumothorax that occurred after transthoracic needle aspiration between 1981 and 1984 were reviewed. During this period, 673 transthoracic-needle-aspiration procedures were performed. Pneumothorax occurred in 160 patients (23.8%), and 78 (11.5%) of these required a chest tube or aspiration. Of the total number of pneumothoraces, 142 (89%) were detected immediately, 15 (9%) were first seen after 1 hr, and only 3 (2%) were first seen on the 4-hr radiograph. Of the pneumothoraces requiring intervention, 69 (88%) were detected immediately while the remainder were first picked up after 1 hr. There were no significant pneumothoraces detected after the 1-hr radiograph. Immediate fluoroscopy and a routine chest radiograph 1-hour postprocedure are recommended. For outpatients 1-hr and 4-hr follow-up radiographs should be taken.
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