BackTable / VI / Podcast / Episode #157
Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching
with Dr. Fred Lee
In Part II of our Lung Biopsy Series Dr. Fred Lee and Dr. Christopher Beck discuss Pleural and Parenchymal Blood Patching to prevent Pneumothorax, including results of the recent JVIR article from Sept 2021.
BackTable, LLC (Producer). (2021, September 28). Ep. 157 – Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Fred Lee
Fred T. Lee Jr, MD is a professor of Radiology, Biomedical Engineering, and Urology, The Robert A. Turrell Professor of Imaging Science, and the Chief of Abdominal Intervention at the University of Wisconsin.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, Dr. Fred Lee and our host Dr. Chris Beck discuss the use of parenchymal and pleural blood patches to reduce the rate of lung biopsy re-interventions.
First, Dr. Lee describes why he has incorporated parenchymal blood patching at the end of most biopsies, noting that it is a straightforward procedure that only adds on a few extra minutes to the overall biopsy, and it can reduce the rate of re-intervention. Both doctors agree that minimizing the need for chest tubes can greatly improve the patient experience.
Pleural blood patches are used as a salvage technique in the event of a pneumothorax. Dr. Lee walks through his process of re-inflating the lung, finishing the biopsy, and using a three-way stopcock to inject blood onto the pleural surface and along the needle track. He notes that there are other valid ways of treating intraprocedural pneumothoraces (saline, fibrin plug, etc); however, he prefers the pleural blood patch because of its liquid-to-solid clotting transition, minimal time, minimal cost, and relatively low risk.
Throughout this episode, we cite data from Dr. Lee’s previous publications, which are cited below.
Percutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies:
CT-Guided Lung Biopsies: Pleural Blood Patching Reduces the Rate of Chest Tube Placement for Postbiopsy Pneumothorax:
Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT–Guided Needle Biopsy:
[Dr. Fred Lee]:
Just assuming that the blood's going to distribute itself fairly uniformly. Now, when you look at a chest x-ray after you do a blood patch, it's really hard to tell that you did anything. Sometimes with a 50 cc blood patch, you might see a tiny little pleural fusion or something. So I have to assume that there's this tiny little rim of blood, very thin, that's surrounding the entire lung. And I'm hoping that gravity will bring more of the blood to the puncture site, but I'm not 100% sure that that's true. So I personally don't make much of a specific effort to get the blood near the puncture site.
[Dr. Christopher Beck]:
Okay. And so going to the paper, in one of the statistics that struck me was that, and you can correct me if I get any of these numbers wrong, but blood patch versus no blood patch, in your sample, it was 5.7% of patients who had a blood patch did not have any complication requiring an intervention. So you may have a pneumothorax, you may have a tiny pneumothorax, but then that new pneumothorax goes on to either be asymptomatic or not enlarge on a chest x-ray, and so no future intervention. So 5.7% with the parenchymal blood patch. And then if you did not have a blood patch, then closer to 14% having a complication that required an intervention, is that right?
[Dr. Fred Lee]:
Those numbers are correct. And this was a result... I have to admit that one of the reviewers... No, I think it was Dan Sze, who's the editor of JVIR, pointed this out to me that in one of the reviews that we had the opportunity within our sample to differentiate what happened to patients that had parenchymal blood patching versus those that didn't have parenchymal blood patching, because our series included some of the early cases where we didn't routinely use a parenchymal blood patch. So it was kind of serendipitous. And honestly, Dan had to point that out to me. I didn't really put that together, that wasn't in the original version of the paper. And so we went back with our revision and we looked and that's exactly right. I was gratified to see that patients that did have a parenchymal blood patch had a lower rate of complications than those that did not.
And this was one more confirmation that blood patching does work, and this has been proven in other studies as well. In fact, I'm not sure that a negative study on this topic has ever been published. And it would have been a little embarrassing if the opposite has been true, because honestly, I didn't know the answer when Dan had pointed out that I had failed to include that in the first version of the paper. But fortunately, it lined up as the previous literature had suggested it was going to be, and in our own experience, too. Thank goodness.
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