Radionuclide Localization > Pitfalls

Pitfalls

Pneumothorax:

As in any CT guided transpulmonary procedure, pneumothorax is the most frequent complication.

Risk of pneumothorax increases with the number of needle passes. The number of passes can be kept very low however compared to CT guided biopsy because we are injecting a substance rather than sampling tissue and much less precise needle placement is required.

The patient will be proceeding to the operating room soon after the CT-guided radionuclide injection. Therefore, even in cases of pneumothorax no immediate intervention by the radiologist is usually necessary unless the pneumothorax is large.

Arrow on the CT image below points to a small pneumothorax.

 

Pulmonary Hemorrhage:

Also as in any CT guided transpulmonary procedure, pulmonary hemorrhage can occur.

The hemorrhage is likely to be contained within a small area of pulmonary parenchyma. Since the patient will be going to the operating room soon after the procedure, pulmonary status will be closely monitored and follow-up imaging can be planned as deemed clinically appropriate by the surgeon.

The CT image on the left below shows a needle positioned within or adjacent to the nodule. The post injection image on the right shows intraparenchymal pulmonary hemorrhage in the region of the nodule.

Injection Issues:

Radiotracer may not be contained focally in the approximate location of the nodule on post-injection scintigraphic images. In our experience, this problem has been very infrequent.

Radiotracer can occasionally be injected into and dispersed throughout pleural space, especially in the setting of a pneumothorax or if the needle backs out of the lung between placement, syringe connection, and tracer injection.

More than one area of focal intraparenchymal activity is occasionally seen, especially if the needle moved during injection.

A second injection can be performed if the first is not located within the lung parenchyma. The more successfully located injection should be clearly documented on the post procedure scintigraphic images. After discussing the situation with the surgeon, clearly marked hard copies of these scintigraphic images can be sent with the patient to the operating suite for clarification.

On the left below is a CT image with a needle in place in a case where a small pneumothorax occurred. On the right is a lateral scintigraphic image of the chest in the same patient after tracer injection showing intense focal activity in the region of the nodule (arrowhead) and fainter activity from tracer layering in the pleural space (arrow).

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