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Trans-thoracic biopsy puncture (or TTBP)

Principle

This is a diagnostic procedure to determine the nature of abnormal formations within the chest. The lesion is marked out using an X-ray check with scanner in most cases, or by fluoroscopy. A single-use sterile needle is introduced into the lesion following administration of local anaesthesia, and a small fragment is then taken for cytological analysis (using a fine needle 0.8mm in diameter) and possibly for histological analysis (in this case using a larger, 2-mm needle) or bacteriological analysis.

 

Technical details of examination:

 

Preparation

- There is need for nil by mouth before this examination.
- Ordinary medicines may be taken (with the exception of anticoagulant treatment).
- Local anaesthesia.
- If necessary, a cough preventive and sedative may be administered.

Contraindications

- Problems with coagulation.
- Severe respiratory insufficiency.

Duration

- 10-30 minutes, depending on difficulties in location.
- After the puncture, the patient must remain in bed for about 30 minutes.
- Several hours of relative rest are then recommended.
- One night must be spent in hospital (under observation). A control chest X-ray is carried out on the day following the puncture, principally to ensure absence of pneumothorax

Inconveniences

Vagal reactions may occur with the pre-medication mentioned above, but are rare.

Complications

- Pneumothorax may occur if the location of the lesion requires passage through part of the lung (detachment of the lung from the chest wall, which may produce no symptoms at all or produce pain and/or difficulty in breathing in the worst cases). More severe cases of pneumothorax may necessitate either evacuation of air around the lung using a needle (known as exsufflation), or insertion of a suction drain into the chest until the small breach in the lung is healed (often 24-48 hours).
- Sputum with blood may be seen during or after the examination, this is usually not serious and disappears spontaneously.

 
What should be done if complications occur?
: As indicated above, air sometimes needs to be sucked out, using needle or drain, if pneumothorax occurs.

 

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