Pleural Biopsy

Overview

A pleural biopsy is a procedure in which a sample of the membrane that surrounds the lungs called the pleural tissue, is extracted during surgery, examined under a microscope and sent for cultures.

It is a procedure performed to determine one or more of, but not limited to the following:

  • Evaluation of an abnormality of the pleura as observed on CT scan of the chest such as thickening of the pleura or a mass/tumour
  • Diagnosis of a pleural infection
  • Examination of fluid in the pleural space, also called pleural effusion

Diagnosis and Treatment

Dr Orr may order blood tests, a chest x-ray or CT scan of the chest to be done prior to the procedure to assist with surgical planning. You may also need some breathing tests to be done before the operation. 

A surgical pleural biopsy can be done one of two ways:

Thoracoscopic (VATS) biopsy

  • A general anaesthetic is administered in order to control ventilation in the lungs and to manage pain. A large tube will be inserted in your airway that allows selective ventilation of one lung while the other is being operated on and is allowed to collapse.
  • Small incisions will be made in your skin along the side of your chest. A long, lighted tube with a camera called a thoracoscope is carefully slid into the pleural space to see the pleural tissue.
  • Biopsies are taken of any abnormal tissue using long instruments inserted through the small incisions. A chest drainage tube is placed through one of the incisions at the end of the procedure and the other incisions are closed. The lung is re-expanded and you are woken from the anaesthetic.

Open Pleural biopsy

  • Sometimes the lung is very stuck to the chest wall and it is not possible to safely insert a camera or other instruments through small holes in the chest. In this case a slightly large single incision is made through which a sample of abnormal tissue is obtained. General anaesthetic is given during the procedure. A drainage tube is left in the chest at the end of the procedure, the incision is closed and you are woken from the anaesthetic.

As with any other surgeries, there may be complications that can happen, some of which are listed below:

  • Air leak from the lung
  • Bleeding
  • Infection
  • Chest pain
  • Blood clots in the legs that can go to the lungs

Prior to Surgery

Dr Orr will explain the procedure to you and the risks and benefits of the procedure.  You will also have the opportunity to ask questions during this meeting.  You will be guided through the consent form by Dr Orr and you will be asked to sign it.  You will be required to stop eating and drinking 6 hours prior to the procedure.  If you have any of the following, please inform Dr Orr:

  • Sensitivity or are allergic to any medications, latex, tape, or local or general anaesthesia
  • Prescription medicine such as anticoagulants like Aspirin, Clopidogrel, Warfarin, over-the-counter medications and/or herbal supplements that you are taking. Dr Orr may advise you to stop taking them for a period before the procedure
  • Possible or confirmed pregnancy
  • Prior diagnostic results that you might have with a previous consultation

You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anaesthesiologist.

What to Expect

On the day before your procedure, you should receive a call from the hospital. You will be given information about the following day, including where to go and when to arrive.

When you arrive, you will be taken to a pre-surgery area so that we can take your vital signs (heart rate, blood pressure, breathing rate, and oxygen level) may be monitored before and during the procedure.  You may be asked to wear pressure socks or firm, elastic socks to help prevent collection of blood in the legs that might cause clots.  You may also receive supplemental oxygen as needed, through a face mask or nasal cannula (tube). 

The actual procedure may 1-2 hours, depending on the kind of procedure you will have.  Your family may wait in the Family Waiting Room.

Recovery

After surgery, you will be taken to the Post Anaesthesia Recovery Unit and will be monitored for any changes in blood pressure, heart rate, and breathing. An IV line will remain in your arm to keep you hydrated and to administer pain medication, if necessary. You may also require the use of a ventilator to ensure air exchange and to prevent pneumonia for a period after surgery.

You will be given oxygen via oxygen mask to aid you during recovery.  Your nurse will encourage you to try sitting up and eventually, moving about, a day after the surgery.  A physiotherapist may see you to give you advice on how to do deep breathing exercises for your further recovery.  Before you go home, your nurse will teach you how to use any equipment you might need, how to care for your incision, and review your medications with you. Gradually, over the course of a few weeks, you will regain your strength and be able to return to work and participate in physical activity.  Be sure to call Dr Orr if you notice any of the following:

  • Bleeding
  • Infection
  • High temperature
  • Allergic reaction, such as redness, swelling, trouble breathing
  • Pain
  • Any of the aforementioned symptoms, whether mild or severe

Always take your medicine exactly as prescribed.  Call Dr Orr if you have any questions or changes.

  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital