Pleural Biopsy

The pleura is a double layer of membranes that surrounds the lungs. A pleural biopsy is a procedure to take a small piece of the pleura

This is done with a special biopsy needle. Or it’s done during surgery. The biopsy is done to look for infection, cancer, or another condition.

There are 3 types of pleural biopsy:

  • Needle biopsy. This is the most common method. A numbing medicine (local anesthetic) is put on the chest. A special needle is put into the pleural membrane to take out a sample. Ultrasound or a CT scan may be used to guide the biopsy needle into the right place.
  • Thoracoscopic biopsy. Medicine is used to put you to sleep (general anesthesia) or local anesthetic is used. A flexible, lighted tube (endoscope) is put into the pleural space. This is the space between the 2 layers of pleura. The endoscope lets the doctor see the pleura and take a piece of tissue.
  • Open biopsy. This is done under general anesthesia. This method is used in the sample from the needle biopsy is too small to get a diagnosis. A cut (incision) in the skin is made to access the lung. A piece of the pleura is removed.

A pleural biopsy may be done to check an abnormal spot of the pleura seen on a chest X-ray or other imaging test, find the cause of a pleural infection or other condition, look for the cause of excess fluid in the pleural space (pleural effusion), find out if a pleural tumor is cancer (malignant) or not cancer (benign) and to get more information after a pleural fluid test shows there may be cancer, tuberculosis (TB), or another infection.

The risks of this procedure may include air in the space between the pleura (pleural space) that causes the lung to collapse (pneumothorax), bleeding in the lung and Infection. Pleural biopsy shouldn’t be done in people with bleeding conditions.

Your doctor will explain the procedure to you. You may be asked to sign a consent form that gives permission to do the procedure. Tell your doctor if you are pregnant, are sensitive to or allergic to any medicines, take any medicines, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements, have had a bleeding disorder or take anticoagulants and aspirin. You may have imaging tests before the procedure. These are done to find the right spot to do the biopsy. These include Chest X-ray, Chest fluoroscopy, Ultrasound and CT scan.

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. You may be asked to remove your clothes. If so, you will be given a hospital gown to wear. You may be asked to remove jewelry or other objects. You may be given oxygen through a nasal tube or face mask. Your heart rate, blood pressure, and breathing will be watched during the procedure. For a needle biopsy, you will be in a sitting position in a hospital bed. Your arms will be resting on an over-bed table. This position helps to spread out the spaces between the ribs, which is where the needle is inserted. If you are not able to sit, you may lie on your side on the edge of the bed. The skin where the needle will be put in will be cleaned with an antiseptic solution. A numbing medicine (local anesthetic) will be injected in the biopsy site. When the area is numb, the doctor will put a needle between the ribs in your back. You may feel some pressure where the needle goes in. One or more samples of pleural tissue will be removed. You will be asked to hold still, exhale deeply, or hold your breath at certain times during the procedure. The biopsy needle will be removed. Firm pressure will be applied to the site until any bleeding has stopped. A bandage or dressing will be put on the area. The tissues samples will be sent to a lab. You may have a chest X-ray taken right after the biopsy.

After the procedure, your blood pressure, pulse, and breathing will be watched. You may have another chest X-ray done a few hours after the procedure. The dressing over the puncture site will be checked for bleeding or other fluid. If you had an outpatient procedure, you will go home when your doctor says it’s OK. Someone may need to drive you home. At home, you can go back to your normal diet and activities if instructed by your doctor. You may need to not do strenuous physical activity for a few days. The biopsy site may be tender or sore for several days. You can take pain medicine as advised by your doctor. Call your doctor if you have Fever of 100.4°F (38°C) or higher, Redness or swelling of the needle site, Blood or other fluid leaking from the needle site, feeling short of breath, Coughing up blood or chest pain.

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