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The most common and therefore potentially the most dangerous are pneumothorax and pulmonary haemorrhage. Mortality from PTLB is rare, but deaths have been reported due to massive haemoptysis, pulmonary Selleckchem BMS-777607 haemorrhage, haemothorax, tension pneumothorax and air embolism. In 1976 Sinner10 reported no deaths from a series of 5300 biopsies but estimated a mortality rate of 0.07%. A more recent postal survey of UK practice by Richardson et?al.11 revealed a mortality rate of 0.15% based on 5444 biopsies. Mortality following biopsy is generally an early event. The likelihood of catastrophic complication is greater in elderly or severely debilitated patients, with the use of larger bore cutting needles and with biopsy of lesions adjacent to central vessels. The operator should be proficient in the insertion of chest drains and emergency bronchoscopic facilities RVX-208 should be available within the institution. Pneumothorax.? There is great variation in the reported rates of pneumothorax in the literature, varying between 0% and 61%, with 3.3�C15% of patients with a pneumothorax requiring a chest drain.10�C15 This variation is in part due to the altered risk depending on the location of the targeted lesion and in part due to the increased sensitivity of CT compared with CXR in detecting pneumothorax. With use of CT it is apparent that many patients develop very small pneumothoraces that are simply not visible on CXR (Fig.?1).14 Factors reported to increase the chances of producing a pneumothorax are: 1 Type of needle used��fine gauge (20�C22?G) needles are less likely to cause this complication than larger (16�C18?G) or cutting needles although many of the series check details showing a difference are based on comparison with non-automated needles under fluoroscopic guidance.10 More recent studies using smaller automated cutting needles have shown complication rates only slightly higher than, or similar to, fine needle aspiration biopsies.16 The majority of pneumothoraces are small and do not require drainage. However, chest drains are needed in approximately 3.3�C15% of patients.12�C14 While a pneumothorax of greater than 30% of the volume of the affected lung is more likely to require a chest drain, the size of the pneumothorax itself is not an indication for drain insertion. The need for chest drain insertion is determined by the development of respiratory compromise or progression in size of the pneumothorax. BTS guidelines suggest initial aspiration of a pneumothorax should be attempted, with subsequent drain insertion only if a leak and significant pneumothorax persist (Fig.?2). In the UK most clinicians attach chest drains to an underwater seal, but a Heimlich one-way flutter valve is a viable alternative.