Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching

[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.