Purpose: To retrospectively evaluate several parameters associated with the occurrence of pulmonary hemorrhage in patients undergoing CT-guided percutaneous lung biopsy (PLB), focusing on pulmonary hypertension (PH).

Methods and Materials: This study enrolled patients with pulmonary lesions, who underwent CT-guided PLB for histological diagnosis. The systolic pulmonary artery pressure (sPAP) was determined using echocardiography. PH was defined as sPAP of 35 mmHg or higher. The pulmonary hemorrhage was classified as follows: grade 0: no hemorrhage; grade 1: hemorrhage with a width of ≤ 2 cm around needle; grade 2: hemorrhage > 2 cm in width and sublobar; grade 3: lobar hemorrhage or greater; and grade 4: hemothorax). Higher-grade pulmonary hemorrhage was defined as grade 2 or higher.

Results: We included 400 patients (mean age: 69 ± 12 years; 206 women) with indeterminate lung lesions who underwent CT-guided PLB. A total of 186 patients had PH at a rate of 46.5%. The rate of patients without PH was 53.5% (214/400). The baseline characteristics of both groups were similar without significant differences except for age. The rate of overall hemorrhage was higher in patients with PH compared to patients without PH (66.7% vs 49.5%; p-value <0.001). The rate of higher-grade hemorrhage in patients with PH was also higher compared to patients without PH (46.2% vs 24.8%; p-value <0.001). No hemorrhage-related deaths were observed in either group. An sPAP threshold of 36 mmHg showed a sensitivity of 72% and specificity of 56% for predicting higher-grade hemorrhage. Size of lung lesion, sPAP, length of intrapulmonary needle path and age were, on both univariate and multivariate analyses, significant factors for higher-grade hemorrhage. Both main pulmonary artery diameter and main pulmonary artery diameter to ascending aorta diameter ratio were not significantly associated with higher-grade hemorrhage in either univariate or multivariate analyses.

Conclusions: Pulmonary hypertension significantly increases the risk of pulmonary hemorrhage in patients undergoing CT-guided lung biopsy. Estimating sPAP using echocardiography prior to biopsy should be integrated into clinical practice to possibly predict pulmonary hemorrhage.