Radiography — Discharge to GP after CT-Guided Biopsy with Pneumothorax Complication
An interventional radiologist writes a discharge letter to the GP following a CT-guided percutaneous lung biopsy in a 63-year-old man, complicated by a small right-sided pneumothorax managed conservatively. The proficient letter must document the complication, confirm safe discharge, and instruct the GP on post-procedure monitoring and the follow-up chest X-ray.
Letter type
Discharge
Write to
General Practitioner
Target length
200–230 words
The case notes
Patient: Mr Aaron Whitfield, 63 years old; CT-guided percutaneous right lower lobe biopsy performed today for a 2.4 cm spiculated lesion (suspicious for bronchogenic carcinoma)
Complication: Post-biopsy CT: small right apical pneumothorax — estimated 15% right hemithorax; patient was monitored for 3 hours; repeat CT at 2 hours showed no enlargement; oxygen saturation maintained 96–98% on room air throughout; patient was asymptomatic
Management: Conservative management — no chest drain required; patient informed of the pneumothorax and discharged with written instruction sheet; oxygen was not required; discharged with a satisfactory post-procedure chest X-ray pending at 48 hours
Pathology: Biopsy specimens sent to histopathology; results expected 5–7 working days; referral to thoracic MDT meeting already arranged once results are available
GP actions requested: (1) 48-hour post-procedure chest X-ray — to confirm resolution of the pneumothorax; (2) patient to report immediately to A&E if: increasing breathlessness, pleuritic chest pain, worsening oxygen desaturation, or sense of increasing chest tightness — these suggest pneumothorax enlargement; (3) do not restart anticoagulants for a further 48 hours (patient was on aspirin 75 mg — held for 5 days pre-procedure; GP to advise on restarting)
Task: Write a discharge letter to the GP, Dr Fatima Al-Hassan, documenting the procedure, the complication, and the GP monitoring instructions.
Writing task
Write a discharge letter to the GP, Dr Fatima Al-Hassan, documenting the procedure, the complication, and the GP monitoring instructions.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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Small right apical pneumothorax: 15%, no enlargement on 2-hour repeat CT, asymptomatic, SpO2 96–98% throughout, conservatively managed — no drain required
The complication must be documented with the outcome. A letter that says 'a pneumothorax occurred' without stating it was monitored, did not enlarge, and did not require drainage leaves the GP without the information needed to calibrate the follow-up urgency.
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The 48-hour chest X-ray request and the A&E warning signs: increasing breathlessness, pleuritic chest pain, desaturation, increasing chest tightness
These are the two GP actions. The chest X-ray is the monitoring plan; the warning signs are the safety net for enlargement after discharge. Both must be explicit, specific, and actionable.
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Aspirin held for 5 days pre-procedure — GP to advise on restarting, currently held 48 hours post-procedure
The anticoagulation management is the GP's specific drug action. They need to know what was held, when it was held, and that their action is to advise on restarting once the pneumothorax is confirmed resolved.
Leave out
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The biopsy technique detail: needle gauge, number of passes, imaging guidance protocol
The radiology procedural report covers the technique. The GP discharge letter covers the outcome, the complication, and the monitoring.
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The histopathology result (not yet available)
Results are expected in 5–7 working days. Stating this and that a thoracic MDT referral is arranged closes the loop. The letter cannot include results that are pending.
Criterion in focus · Content
A post-procedure discharge letter following a complication must answer four questions: (1) what happened (pneumothorax), (2) how it was managed (conservative, monitored 3 hours, no enlargement), (3) what the current status is (asymptomatic, SpO2 satisfactory at discharge), (4) what the GP must do (48-hour CXR, warning signs, anticoagulant restart). A letter that answers three of four fails Content. In this case, the anticoagulant restart is the most commonly omitted item — and it is the most clinically dangerous omission.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.