Objective:To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods:This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results:A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions:Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.
The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA-68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.The fusion image technique combines the real–time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.
A 56-year-old male patient underwent percutaneous biopsy of a nodule in the right lung apex ( Figure 1A). The tip of a 19-gauge coaxial needle was positioned in the posterior chest wall ( Figure 1B), and six samples of the lesion were obtained with a 20-gauge core needle. The pathological analysis revealed squamous cell carcinoma. Using an anterior approach, we performed right upper lobectomy with tumor-free margins. At 6 months of follow-up, a positron emission tomography-CT scan of the chest showed an 18 F-fluorodeoxyglucose-avid soft tissue mass ( Figure 1C) in the T3-4 interspace, along the biopsy tract, as well as bone erosion of the right third rib posteriorly ( Figure 1D), suggesting tumor seeding. A subsequent CT scan of the chest, obtained two months later, confirmed local disease progression. We then performed en bloc resection with disease-free pleural margins, and the pathological analysis confirmed that tumor seeding had occurred.Tumor seeding along the biopsy route is exceedingly rare. Certain factors, such as the use of large-bore cutting needles, increase the risk of such tumor cell dissemination, that risk also being greater when the tumor is an adenocarcinoma. RECOMMENDED READINGKim JH, Kim YT, Lim HK, Kim YH, Sung SW. Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy; Eur J Cardiothorac Surg. 2003;23(5):828-32. http://dx.doi.
O trauma é uma importante causa de morbimortalidade em todo o mundo e, nesse contexto, o trauma de face é considerado uma das lesões mais devastadoras, devido às possíveis lesões encefálicas e às consequências emocionais relacionadas a deformidades estéticas. Os principais mecanismos de trauma envolvidos nessas lesões são acidentes automobilístico, seguido de agressões, queda de altura e acidentes esportivos. A tomografia computadorizada, amplamente utilizada no trauma, tornou-se o método de imagem de escolha na avaliação desses pacientes, sendo importante na identificação precisa das estruturas comprometidas, orientando a melhor abordagem terapêutica. As diversas formas de apresentação do trauma de face vêm se mostrando verdadeiros desafios na reconstrução funcional e estética desses pacientes, logo, a boa comunicação entre os diversos profissionais envolvidos no tratamento desses pacientes é essencial, especialmente entre radiologistas e cirurgiões. Os objetivos desta revisão são descrever os principais tipos de fraturas de face e discorrer sobre os achados de imagem mais relevantes no seu tratamento
The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.
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