There are few reports of transthoracic needle biopsy (TNB) in elderly (>70 years) patients although there is some evidence that age may be a risk factor in developing pneumothorax. We report our experience of 38 patients, age range 70-90 years, who underwent computed tomography (CT)-guided TNB for suspected malignancy of the chest, with particular reference to sensitivity and complication rate following the procedure. The biopsy was obtained using either a spinal needle or, if appropriate, a core of tissue was obtained using a cutting needle. The biopsy showed evidence of malignancy in 27 patients. Pneumothorax occurred in 10 of 40 biopsies. Two patients with pneumothorax required pleural drains; one was discharged the following day and the other required drainage for 3 days. Haemoptysis was not a problem but occurred as a transient postbiopsy event in three patients. In 26 of 40 (65%) episodes the patients were sent home within 24 h of the diagnostic procedure. It is thus quite possible to undertake the procedure on a day case basis. CT-guided TNB is a safe and reliable procedure in elderly patients with suspected chest malignancy and is well tolerated.