Pulmonary Hemorrhage and Pneumothorax Risk During CT-Guided Lung Biopsy for Suspected Lung Cancer

Objectives: The aim of this study was to evaluate the association between pulmonary hemorrhage and PTX following CT-guided lung biopsy for suspected or confirmed lung malignancy and to assess whether lesion depth modifies this relationship. Methods: This retrospective single-center study included 118 consecutive patients undergoing CT-guided lung biopsy for oncologic indications between 2020 and 2025 (66 men, 52 women; median age 69 years). Immediate post-biopsy CT was assessed for PTX and focal pulmonary hemorrhage. Multivariable logistic regression identified predictors of PTX, including pulmonary hemorrhage, lesion size and depth, chronic obstructive pulmonary disease, patient positioning, age, and sex. An interaction analysis evaluated effect modification by lesion depth. Results: PTX occurred in 22.0% of biopsies, and pulmonary hemorrhage in 29.7%. PTX was significantly less frequent in patients with pulmonary hemorrhage (p = 0.021). Lesion depth showed a borderline association with PTX risk (OR 1.02 per mm; p = 0.060). Pulmonary hemorrhage demonstrated a nonsignificant protective trend (OR 0.33; p = 0.135). The hemorrhage–depth interaction approached significance (p = 0.065), suggesting attenuation of depth-related PTX risk. Model discrimination was moderate (AUC = 0.709). Conclusions: In patients undergoing CT-guided biopsy for lung cancer evaluation, pulmonary hemorrhage may mitigate PTX risk, particularly for deeper lesions.