Work

Pleural tail sign in computed tomography-guided lung biopsy: an imaging predictor of severe pneumothorax requiring chest tube placement

Year: 2025

Type: article

Abstract: Pneumothorax is the most common complication following computed tomography (CT)-guided percutaneous transthoracic needle biopsy.In severe cases, it may require chest tube placement, which is associated with increased morbidity.The aim of this study was to evaluate the prognostic value of the pleural tail sign (PTS) as an imaging marker for predicting pneumothorax incidence and severity after lung biopsy. METHODSA total of 477 patients (mean age 65 ± 11.7 years, 37.2% women) undergoing CT-guided lung biopsies between 2012 and 2021 were retrospectively analyzed in this study.The presence and morphological subtype of PTS-classified as thin PTS or triangular PTS-were assessed on pre-interventional CT imaging.Associations between PTS and pneumothorax outcomes were evaluated using univariate and multivariate binary logistic regression analyses. RESULTSNo statistically significant association was found between the overall presence of PTS and the incidence of pneumothorax (P = 0.052).However, patients with a triangular PTS showed a significantly increased risk of severe pneumothorax requiring chest tube placement (odds ratio: 2.092, 95% confidence interval: 1.097-3.990,P = 0.025), whereas a thin PTS did not show a statistically significant effect (P = 0.456). CONCLUSIONAlthough PTS does not reliably predict overall pneumothorax risk after CT-guided lung biopsy, its triangular subtype may serve as a prognostic imaging marker for identifying patients at increased risk of severe pneumothorax requiring chest tube placement. CLINICAL SIGNIFICANCEThe identification of a triangular PTS on pre-interventional CT imaging may help to stratify patients at higher risk of severe pneumothorax following CT-guided lung biopsy.This could enable more informed procedural planning, potentially leading to improved patient outcomes.

Source: Diagnostic and Interventional Radiology

DOI: 10.4274/dir.2025.253503