What causes iatrogenic pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Causes of iatrogenic pneumothorax include the following:

  • Transthoracic needle aspiration biopsy of pulmonary nodules (most common cause, accounting for 32-37% of cases)
  • Transbronchial or pleural biopsy
  • Thoracentesis
  • Central venous catheter insertion, usually subclavian or internal jugular [16]
  • Intercostal nerve block
  • Tracheostomy
  • Cardiopulmonary resuscitation (CPR) - Consider the possibility of a pneumothorax if ventilation becomes progressively more difficult.
  • Acute respiratory distress syndrome ( ARDS) and positive pressure ventilation in the ICU - High peak airway pressures can translate into barotrauma in up to 3% of patients on a ventilator and up to 5% of patients with ARDS. [17]
  • Nasogastric feeding tube placement

Iatrogenic pneumothorax is a complication of medical or surgical procedures. It most commonly results from transthoracic needle aspiration. Other procedures commonly causing iatrogenic pneumothorax are therapeutic thoracentesis, pleural biopsy, central venous catheter insertion, transbronchial biopsy, positive pressure mechanical ventilation, and inadvertent intubation of the right mainstem bronchus. Therapeutic thoracentesis is complicated by pneumothorax 30% of the time when performed by inexperienced operators in contrast to only 4% of the time when performed by experienced clinicians.

The routine use of ultrasonography during diagnostic thoracentesis is associated with lower rates of pneumothorax (4.9% vs 10.3%) and need for tube thoracostomy (0.7% vs 4.1%). Similarly, in patients who are mechanically ventilated, thoracentesis guided by bedside ultrasonography without radiology support results in a relatively lower rate of pneumothorax.

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