Cardiothoracic Imaging| Volume 95, P92-96, March 2023

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Radiologic and histopathologic features of hydrogel sealant after lung resection in participants of a prospective randomized clinical trial

Published:December 26, 2022DOI:


      • Hydrogel plugs used after lung biopsies will likely be encountered more frequently.
      • It is important to know the imaging and histological appearance of hydrogel plugs.
      • On imaging, hydrogel plugs are described as linear, serpiginous or lobular.
      • On histology, hydrogel plugs are described as foamy or mesh-like.
      • Hydrogel plugs did not affect tumor staging.



      To summarize imaging and histopathologic characteristics of hydrogel sealant (plug) in lung parenchyma and assess their correlation with time since deployment of sealant.

      Materials and methods

      Among a total of 208 participants randomized to the hydrogel sealant arm of a lung biopsy prospective randomized clinical trial, 51 underwent resection of the biopsied lesion. In 34 participants sealant material was present on histopathologic sections (n = 22), or they had cross-sectional imaging of chest between biopsy and resection (n = 23) or they had both imaging and histopathology (n = 11). Histopathologic and imaging findings were described. The association of these findings with time since sealant deployment was evaluated using the Wilcoxon rank sum test.


      The mean time since sealant deployment for histopathology was 45.7 days (median 36, range 14–181) and for imaging studies was 99 days (median 32, range 4–527). The sealant was infiltrated by inflammatory cells in 20 (91%) participants. The main general histopathologic pattern of sealant was foamy in 12 (57%) and mesh in 8 (38%) participants. Imaging appearance of sealant was serpiginous in 18 (60%), linear in 10 (33%) or lobulated in 2 (6.7%) participants. In 2 participants the sealant was hypermetabolic with no histopathologic evidence of tumor. No correlation was found between time since sealant deployment and imaging or histopathologic appearances.


      Hydrogel sealant appears as a serpiginous, linear, or lobulated opacity on cross-sectional imaging which can be metabolically active. It is associated with an inflammatory reaction with a foamy or mesh general pattern on histopathological assessment. No correlation was found between time since sealant deployment and imaging or histopathologic appearances.


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        • Force USPST
        Screening for lung cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2021; 325: 962-970
        • Marshall D.
        • LaBerge J.M.
        • Firetag B.
        • Miller T.
        • Kerlan R.K.
        The changing face of percutaneous image-guided biopsy: molecular profiling and genomic analysis in current practice.
        J Vasc Interv Radiol. 2013; 24: 1094-1103
        • Lokhandwala T.
        • Bittoni M.A.
        • Dann R.A.
        • et al.
        Costs of diagnostic assessment for lung cancer: a medicare claims analysis.
        Clin Lung Cancer. 2017; 18: e27-e34
        • Maybody M.
        • Muallem N.
        • Brown K.T.
        • et al.
        Autologous blood patch injection versus hydrogel plug in CT-guided lung biopsy: a prospective randomized trial.
        Radiology. 2018; 290: 547-554
        • Ahrar J.U.
        • Gupta S.
        • Ensor J.E.
        • et al.
        Efficacy of a self-expanding tract sealant device in the reduction of pneumothorax and chest tube placement rates after percutaneous lung biopsy: a matched controlled study using propensity score analysis.
        Cardiovasc Intervent Radiol. 2017; 40: 270-276
        • Yousem S.A.
        • Amin R.M.
        • Levy R.
        • Baker N.
        • Lee P.
        Pulmonary pathologic alterations associated with biopsy inserted hydrogel plugs.
        Hum Pathol. 2019; 89: 40-43
        • Butnor K.J.
        • Bodolan A.A.
        • Bryant B.R.E.
        • Schned A.
        Impact of histopathologic changes induced by polyethylene glycol hydrogel pleural sealants used during transthoracic biopsy on lung cancer resection specimen staging.
        Am J Surg Pathol. 2020; 44 (
        • de Groot P.M.
        • Shroff G.S.
        • Ahrar J.
        • et al.
        Implications for high-precision dose radiation therapy planning or limited surgical resection after percutaneous computed tomography-guided lung nodule biopsy using a tract sealant.
        Adv Radiat Oncol. 2018; 3: 139-145