PMC9935949_01
Case 1. Hematoma-filled pneumatocele after PTNB in a 74-year-old male with primary lung cancer.. A. A chest CT image obtained before PTNB shows a 22-mm-sized, lobulated contoured nodule in the apicoposterior segment of the left upper lobe.. B. A chest CT image obtained during PTNB shows the needle tip located outside the tumor.. C, D. The CT images obtained immediately after PTNB show a 3-mm-sized, air-filled cystic lesion in the path of the biopsy needle (arrowheads, C), suggesting a pneumatocele. The image shows extension along the adjacent bronchovascular bundle (arrowhead, D). In addition, accompanied ground-glass opacity and consolidation due to hemorrhage and ipsilateral pneumothorax can be observed.. E. A CT image obtained 10 days after PTNB shows a well-defined, tubular-shaped, non-enhancing nodule with heterogeneous attenuation (arrowhead) in the area where pneumatoceles had been previously observed.. F.
18FDG PET/CT obtained 14 days after PTNB shows no hypermetabolism in the nodule (arrowhead), whereas the adjacent tumor shows hypermetabolism (SUVmax, 6.0) (arrow).. FDG = fluorodeoxyglucose, PTNB = percutaneous transthoracic needle biopsy, SUVmax = maximum standardized uptake value
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F1
Prior to biopsy, a CT scan of the thorax was conducted to determine needle trajectory and depth to be inserted, which showed a 22 mm-sized, lobulated contoured nodule in the left upper lobe apicoposterior segment (Fig. 1A). We located the needle tip outside the tumor (Fig. 1B), and specimen acquisition was performed once. An immediate post-biopsy CT scan of the entire thorax revealed a 3-mm-sized, air-filled cystic lesion in the path of the biopsy needle, which suggested a pneumatocele (Fig. 1C). It showed extension along the adjacent bronchovascular bundle (Fig. 1D). It presented well-defined, tubular-shaped, non-enhancing nodules with heterogeneous attenuation (15-45 Hounsfield unit [HU] on pre-contrast images) in the area where pneumatoceles had been previously observed (Fig. 1E). On 18F-fluorodeoxyglucose (FDG) PET/CT for the staging of primary lung cancer, there was no hypermetabolism in the nodules, whereas adjacent primary lung cancer showed hypermetabolism (maximum standardized uptake value [SUVmax], 6.0) (Fig. 1F).
PMC9935949_02
Case 2. Hematoma-filled pneumatocele after PTNB in a 69-year-old male with primary lung cancer.. A. A chest CT image obtained before PTNB shows a 24-mm-sized, microlobulated nodule with pseudocavitation in the anterior segment of the left upper lobe.. B. A chest CT image obtained during PTNB shows the needle tip located outside the tumor, targeting the lower aspect of the tumor.. C. The CT image obtained immediately after PTNB shows a 3-mm-sized, air-filled cystic lesion along the path of the biopsy needle (arrowhead), suggesting a pneumatocele. In addition, accompanied ground-glass opacity and consolidation due to hemorrhage can be observed.. D. A CT image obtained seven days after PTNB shows a 14-mm-sized, well-defined, tubular-shaped, non-enhancing nodule with heterogeneous attenuation (arrowhead) in the area where a pneumatocele had been previously observed.. E.
18FDG PET/CT obtained seven days after PTNB shows no hypermetabolism in the nodule (arrowhead), whereas the adjacent tumor shows mild hypermetabolism (SUVmax, 2.4) (arrow).. FDG = fluorodeoxyglucose, PTNB = percutaneous transthoracic needle biopsy, SUVmax = maximum standardized uptake value
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F2
Chest CT obtained before biopsy showed a 24 mm-sized, microlobulated contoured nodule with pseudocavitation in the anterior segment of the left upper lobe (Fig. 2A). The needle tip was located outside the tumor (Fig. 2B), and specimen acquisition was performed four times. This suggested a pneumatocele with pulmonary hemorrhage (Fig. 2C). It presented a 14-mm-sized, well-defined, tubular-shaped, non-enhancing nodule with heterogeneous attenuation (20-42 HU on pre-contrast images) in the area where a pneumatocele had been previously observed, such as in Case 1 (Fig. 2D). On 18FDG PET/CT, there was no hypermetabolism in the nodule, whereas adjacent primary lung cancer showed hypermetabolism (SUVmax, 2.4) (Fig. 2E).