Pneumothorax complicates about a quarter of CT-guided lung biopsies, and 5–6% need a chest drain. This meta-analysis pooled seven studies and 1,455 patients (680 given saline) comparing immediate instillation of sterile saline into the needle tract against no sealing.
Saline tract sealing reduced pneumothorax (risk ratio 0.46, 95% CI 0.35 to 0.61) and cut the need for a chest drain by nearly four-fifths (risk ratio 0.22, 95% CI 0.12 to 0.42). The technique is inexpensive, uses material already on the trolley, and avoids the cost and local reactions of blood-patch or glue methods.
This is a cheap adjunct with a large, consistent effect on a common complication. It is a reasonable default to adopt for percutaneous lung biopsy, particularly for higher-risk trajectories.
- Instil sterile saline into the tract as the needle is withdrawn
- Pneumothorax roughly halved; chest-drain need cut by about 78%
- Cheaper and simpler than autologous blood, fibrin glue or collagen plugs
- Seven studies, 1,455 patients — mixed RCT and comparative cohort evidence
The statistics, in plain English
A risk ratio of 0.46 means the saline group had 46% of the pneumothorax risk of controls — a 54% relative reduction; the interval (0.35 to 0.61) stays well below 1.0, so the benefit is clear. The chest-drain risk ratio of 0.22 is larger still, though its wider interval reflects fewer events. Pooling RCTs with cohort studies lowers certainty a little, but the direction is consistent.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for radiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free