Open pleural biopsy

Definition

An open pleural biopsy is a procedure to remove and examine the tissue that lines the inside of the chest. This tissue is called the pleura.

Alternative Names

Biopsy - open pleura

How the Test is Performed

An open pleural biopsy is done in the hospital using general anesthesia. This means you will be asleep and pain free. A tube will be placed through your mouth down your throat into your windpipe (trachea) to help you breathe.

The surgery is done in the following way:

• After cleaning the skin, the surgeon makes a small cut in the left or right side of the chest.
• The ribs are gently separated.
• A scope may be inserted to see the area to be biopsied.
• Tissue is taken from inside the chest and sent to a lab for examination.
• After surgery, the wound is closed with stitches.
• Your surgeon may decide to leave a small plastic tube in your chest to prevent air and fluid from building up.

Your breathing tube may not be able to be removed right after surgery. So, you may need to be on a breathing machine for some time.

How to Prepare for the Test

You should tell your surgeon if you are pregnant, allergic to any medicines, or if you have a bleeding problem. Be sure to tell your surgeon about all the medicines you take, including herbs, supplements, and those bought without a prescription.

Follow your surgeon's instructions for not eating or drinking before the procedure.

How the Test will Feel

When you wake up after the procedure, you will feel drowsy for several hours.

There will be some tenderness and pain where the surgical cut is located. Most surgeons inject a long-acting local anesthetic at the surgical cut site so that you will have very little pain right afterward.

You may have a sore throat from the breathing tube. You can ease the pain by eating ice chips.

You may have a tube in your chest to remove air. This will be removed later.

Why the Test is Performed

This procedure is used when the surgeon needs a larger piece of tissue than can be removed with a pleural needle biopsy. The test is most often done to check for mesothelioma, a type of tumor that affects the pleura.

It is also done when there is fluid in the chest cavity, or when a direct view of the pleura and the lungs is needed.

This procedure may also be done to examine a metastatic pleural tumor. This is a type of cancer that has spread from another organ to the pleura.

Normal Results

The pleura will be normal.

What Abnormal Results Mean

Abnormal findings may be due to:

• Abnormal tissue growth (neoplasms)
• Certain infections (bacterial, viral, fungal, or parasitic)
• Mesothelioma
• Tuberculosis

Risks

There is a slight chance of:

• Air leak
• Excess blood loss
• Infection
• Injury to the lung
• Collapsed lung (pneumothorax)

References

Verschakelen JA, Gleeson F, Tsakok M. The chest wall, pleura, diaphragm and intervention. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 3.

Wald O, Izhar U, Sugarbaker DJ. Lung, chest wall, pleura and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 58.