Overview
Pleural Biopsy is a diagnostic procedure used to obtain tissue samples from the pleura for histological examination. It is essential for diagnosing pleural diseases and malignancies.
Pleural biopsy is crucial for diagnosing pleural malignancies, tuberculosis, and other pleural diseases. It provides tissue diagnosis when cytology is inconclusive.
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Indications
Suspected mesothelioma or metastasis
Suspected pleural TB
When cytology is inconclusive
Suspicious pleural thickening
Recurrent pleural effusion
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, ultrasound guidance, sterile technique setup, and monitoring equipment. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient, prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
- Incomplete sterile prep
💡 Pro Tip:
Position patient sitting with arms forward.
Step 2: Site Selection
Choose insertion site with ultrasound guidance.
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Poor ultrasound visualization
💡 Pro Tip:
Use ultrasound to identify optimal site.
Step 3: Local Anesthesia
Infiltrate local anesthetic at insertion site.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Anesthetize skin, subcutaneous tissue, and pleura.
Step 4: Needle Insertion
Insert biopsy needle under ultrasound guidance.
⚠️ Common Mistakes to Avoid:
- Wrong insertion
- Lung injury
💡 Pro Tip:
Always confirm pleural space before biopsy.
Step 5: Biopsy Collection
Collect multiple biopsy specimens.
⚠️ Common Mistakes to Avoid:
- Inadequate specimens
- Poor quality
💡 Pro Tip:
Collect 3-6 specimens for adequate sampling.
Step 6: Specimen Handling
Place specimens in formalin, label properly.
⚠️ Common Mistakes to Avoid:
- Poor preservation
- Wrong labeling
💡 Pro Tip:
Preserve specimens in formalin immediately.
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Post-procedure Care
Post-procedure care involves monitoring for complications, chest X-ray confirmation, and analysis of biopsy specimens.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Pneumothorax | 5-10% | Chest pain, dyspnea | Chest X-ray, chest tube if needed | Ultrasound guidance |
| Bleeding | 2-5% | Hemoptysis, hypotension | Pressure, monitoring | Ultrasound guidance |
| Infection | 1-3% | Fever, erythema | Antibiotics | Sterile technique |
| Tumor seeding | 1-2% | Chest wall mass | Surgical excision | Proper technique |
Clinical Pearls
Use ultrasound guidance for safer insertion.
Position patient sitting with arms forward.
Always confirm pleural space before biopsy.
Collect 3-6 specimens for adequate sampling.
Preserve specimens in formalin immediately.
Use sterile technique throughout the procedure.
Monitor for complications post-procedure.