Letter: Fatal complication in percutaneous needle biopsy of the lung.

The danger of percutaneous needle biopsy of the lung has been emphasized by the recent report of two additional fatal cases.' The authors review the published fatalities in the English literature, pointing out that they have occurred, except in one case,2 after the use of cutting needles. We have published our own results3 in 18 patients submitted to biopsy with the high speed trephine presented by Steel and Winstanle~.~ One of these patients died in a few minutes after a sudden endobronchial hemorrhage. The patient had been treated with tracheotomy and a positive pressure respirator for two months for acute polyradiculoneuritis. The biopsy was proposed in order to diagnose the cause of several ill-defined lung shadows which had been associated with development of pneumothorax. The patient was breathing spontaneously, but still tracheotomized, when the procedure was carried out. About 500 ml of blood was aspirated from the trachea and positive pressure ventilation was immediately instituted. The patient became comatose and developed circulatory collapse followed quickly by cardiac arrest, from which she could not be revived. At autopsy, many areas of chronic pneumonitis were observed. Adjacent to one of them, a bronchiectatic area was found with a tear on the bronchial wall and hypertrophied bronchial arteries in the immediate vicinity. The tear was attributed to the biopsy since a bronchial fragment had been found in the specimen and a hemorrhagic linear tracing reached it. All these facts point to the possibility of perforation of a bronchial artery as the cause of hemorrhage. Since both lungs were found to be full of blood, we believe that acute respiratory failure was the cause of death. Since then a Carlens dserential bronchial catheter is always available during the biopsy procedure. Since our study was published, 19 more patients have been submitted to biopsy without serious complications. Aquiles]. Roncoroni, M.D., F.C.C.P. Medical Director, Centro de Rehabilitacidn Respiratoriu "Maria FerreP Buenos Aires, Argentina 1 Norenberg R, Claxton CP Jr, Takaro T: Percutaneous needle biopsy of the lung: Report of two fatal complications. Chest 66:216-218, 1974 2 Boylen CT, Johnson NR, Richters V, et al: High speed trephine lung biopsy: Method and results. Chest 63:59, 1973 3 Roncoroni AJ, Olrnedo G , Herrera MR: Biopsia pulmonar Percutanea (Trkpano de Steel). Medicina 33: 695,1973 4 Steel SJ, Winstanley DP: Trephine biopsy of the lung and pleura. Thorax 24:576, 1969