From Needle Biopsy to Pneumothorax

The initial procedure of my needle biopsy was quite simple. But there is a fairly common complication that I encountered shortly after the needle was removed. It is called a "pneumothorax" and it is essentially the creation of an air bubble outside of the lung that causes the lung to collapse.

In my case, I was fortunate that it was a small pneumothorax and there was no immediate threat of the lung actually collapsing in on itself. There was still a real danger of this happening if it failed to stabilize, however, and so I was kept overnight for observation and X-rayed at regular intervals.

Diagnosing the pneumothorax

Immediately following the needle biopsy, I received an X-ray that indicated the procedure had gone well. Not long after that, I had a coughing fit that quite likely pushed air through the tiny hole left from the needle before it could heal up completely. A second X-ray was given to me shortly thereafter, revealing the pneumothorax.

At that point, I was scheduled for a series of X-rays to chronical the state of the pneumothorax and help the doctors determine their course of action. I was also administered oxygen through a nasal tube that continued throughout the process. At first, it was proposed that the oxygen alone might be enough to help resolve the issue quickly.

Ventilation tube

When the air pocket did not shrink within a couple of hours, it was determined that there was enough air outside the lung to warrant the insertion of a ventilation tube. I was rolled back to the CT scanning room where the doctor took another look at the area in three dimensions and determined the best position for a second hole in my chest.

The ventilation tube required a slightly larger incision than the needle for the biopsy, however this one did not need to enter the lung -- it was only going through the chest wall into the gap outside of the lung. A very narrow tube was then fed into the space, curling into the shape of a little "pigtail" that showed up on the CT scan, just outside of the lung.

At the end of the flexible hose now coming out of my chest was what looked like a narrow balloon inside of a test tube. This was a one-way vent, allowing air to be expelled through the "balloon" without allowing any fresh air to be pulled back in. At first, I could watch it quiver as I exhaled, but as the hours stretched on the air released through the balloon was less visible. This was a good sign, as there was progressively less air being forced out.

Hospitalization and returning home

Although the vent appeared to be working fine, I was kept overnight for observation. I did cough a few more times, even harder than before, but the initial puncture seemed to have healed up. Now, the coughing probably sped the release of air causing the pneumothorax. By early morning, I had been cleared to have the tube removed and prepared to go home. Still, I was cautioned to watch for signs that the lung might be collapsing or for signs of an infection.

The process of removing the air vent was done without any numbing medication. The tube was clipped with some scissors and I was instructed to hum while the little pigtail was quickly and smoothly pulled from my chest. The humming applied just a small amount of pressure from my lungs, making the removal an easy experience. All it took to seal the wound was a simple dressing, which I was able to replace by a single band-aid the next afternoon.

Moving on to my next treatment

I took things slowly the following two days, trying to keep my persistent cough under control while gauging how my breathing was improving. A small pneumothorax will generally resolve itself within a few days. My air pocket could actually be felt under the skin by gently pressing against it. This way I was able to see and feel how it dissipated and within three days it was mostly gone, only a little air lingering under the skin that would naturally be absorbed over time. A quick follow up with my oncologist confirmed that the process had been successful and I was back on track for my next line of treatment.^1-5

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.