{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:32:12Z","timestamp":1785407532914,"version":"3.56.0"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: CT-guided transthoracic core needle biopsy (CT-TTNB) is the standard technique for histological characterization of pulmonary lesions, yet it carries a 15\u201342% rate of pneumothorax and a 5\u201327% rate of alveolar hemorrhage. Accurate identification of modifiable and non-modifiable procedural determinants is essential for pre-procedural risk stratification, technique optimization, and post-procedural care. Methods: We conducted a single-centre retrospective cohort study of 240 consecutive CT-TTNB procedures performed between November 2023 and January 2025. The variables were extracted from medical records and PACS and entered into univariate and multivariate analysis models. Model performance was assessed by AUC-ROC, Nagelkerke R2, and the Hosmer\u2013Lemeshow test. Results: Pneumothorax occurred in 79 patients (32.9%), with chest tube drainage required in 14 (5.8%). Alveolar hemorrhage was identified in 49 patients (20.4%). Four independent predictors for pneumothorax were identified: needle\u2013pleural angle (OR 0.837\/1\u00b0; p &lt; 0.001), pleura-to-lesion distance (OR 1.675\/10 mm; p &lt; 0.001), fissure traversal (OR 26.718; p = 0.003), and patient age (OR 1.076\/year; p = 0.002); AUC-ROC 0.927. The alveolar hemorrhage model identified pleura-to-lesion distance (OR 1.768\/10 mm; p &lt; 0.001), RUL apical segment (OR 4.281; p &lt; 0.001), and carcinomatous lymphangitis as protective factors (OR 0.359; p = 0.030); AUC-ROC 0.822. The needle\u2013pleural angle was not independently associated with alveolar hemorrhage, confirming mechanistically distinct complication pathways. Conclusions: Needle\u2013pleural angle is the dominant modifiable determinant of pneumothorax and pneumothorax-related complications. Optimizing the trajectory towards perpendicularity does not increase hemorrhage risk. These findings support the implementation of angle-based trajectory planning protocols and risk-stratified post-procedural monitoring.<\/jats:p>","DOI":"10.3390\/diagnostics16121848","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:00:48Z","timestamp":1781535648000},"page":"1848","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Pneumothorax and Alveolar Hemorrhage After CT-Guided Lung Biopsy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7606-6001","authenticated-orcid":false,"given":"Amalia","family":"Constantinescu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"},{"name":"Department of Radiology and Medical Imaging, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2664-7645","authenticated-orcid":false,"given":"Alessia-Stephania","family":"Ro\u0219ian","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu-Nicolae","family":"C\u0103prariu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4216-3176","authenticated-orcid":false,"given":"Ionel-Alin","family":"Muntean","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-1925","authenticated-orcid":false,"given":"Versavia Maria","family":"Ancu\u0219a","sequence":"additional","affiliation":[{"name":"Department of Computer and Information Technology, Automation and Computers Faculty, \u201cPolitehnica\u201d University of Timisoara, Vasile P\u00e2rvan Blvd, No. 2, 300223 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alin Ciprian","family":"Nicola","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, Gheorghe Adam No. 13, 300226 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pulmonology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4602-7730","authenticated-orcid":false,"given":"Diana","family":"Manolescu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, Gheorghe Adam No. 13, 300226 Timi\u0219oara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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