Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results.

Langen, H.-J.; Klose, Klaus-Christian; Keulers, P; Adam, G.; Jochims, Markus; Rw, Günther

doi:10.1148/radiology.196.3.7644632

Cited by 46 publications

(17 citation statements)

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“…Preoperative recognition of risk factors may lead to their correction, by administration of antitussives or bronchodilatators [54], or to the use of more sophisticated techniques, such as a co-axial needle technique, using a larger needle as a guide. In all cases, transgression of the needle through bullae should be avoided and the needle path through the normal lung should be kept to a minimum [80,81] (®g. 3).…”

Section: Complicationsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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Interventional Radiology is a technique based medical specialty, using all available imaging modalities (¯uoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes.Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides ®ne needle aspiration. Any pleural, pulmonary or mediastinal¯uid or gas collection is amenable to percutaneous pulmonary catheter drainage.Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands.Computed tomography is helpful in pre-and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.

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Section: Complicationsmentioning

confidence: 99%

Imaging guided thoracic interventions

Ghaye¹,

Dondelinger²

2001

Eur Respir J

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“…This technique was previously used for pulmonary and mediastinal lesions [9,10], but the only author that described its use for adrenal lesions was Karampekios et al [11]. In our study, despite the reduced sample size, the method proved to be safe with no reported complications.…”

Section: Discussionmentioning

confidence: 53%

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection—a safe and technically easy approach

Tyng

Bitencourt

Martins

et al. 2012

BJR

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ABSTRACT. The adrenal glands are an important site of both primary and secondary disease processes. Image-guided percutaneous biopsy of the adrenal gland is an accurate and safe alternative to surgical biopsy. This procedure is most often performed in patients with a suspicion of metastatic disease where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. There are many different approaches to performing adrenal biopsy under CT guidance such as anterior transhepatic/transpancreatic, lateral transhepatic/transplenic or posterior transpulmonary/transpleural/paravertebral. We describe a technique in which the adrenal gland was biopsied using a CT-guided percutaneous paravertebral approach with the use of a hydrodissection manoeuver. 13 CT-guided adrenal gland percutaneous biopsies using this technique were performed at our institution between April 2009 and July 2010. All biopsies yielded sufficient material for pathological analysis and there were no complications reported after the procedure. Saline injection can expand the posterior paravertebral space and facilitate a posterior extrapleural approach with high accuracy and low complication rates, and we believe that this may be the best approach for adrenal gland biopsy.

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“…Multiple scans are obtained between incremental needle advancement to check trajectory to ensure internal mammary vessels are not in path. A 22 gauge needle can be used inject saline solution or dilute contrast medium to widen the mediastinum and create an artificial extra-pleural path for needle placement [1,4]. After creation of a safe extra-pleural window, a 22 gauge needle is removed and a large bore needle (18-gauge or larger) guide needle is advanced.…”

Section: Discussionmentioning

confidence: 99%

“…After creation of a safe extra-pleural window, a 22 gauge needle is removed and a large bore needle (18-gauge or larger) guide needle is advanced. By using a coaxial technique, fine-needle aspiration and core biopsies are performed through the guide needle [1,4].…”

Section: Discussionmentioning

confidence: 99%

A rare complication of mediastinal mass biopsy

Patel¹,

Shah²,

Kahl³

et al. 2017

Vascul Dis Ther

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27 year old female with history of atherosclerotic cardiovascular disease and remote myocardial infarction, asthma and provoked deep vein thrombosis (completed anticoagulation) presented with complaints of worsening chest pain and dyspnea for two days. She denied fever, chills, productive cough or sick contacts. She admitted to 70-pound unintentional weight loss over 7 months, decreased appetite, night sweats, diarrhea, and palpitations.Vital signs showed heart rate 95, blood pressure 113/74 mmHg, respiratory rate 14, SpO2 95% on room air. A comprehensive metabolic panel and complete blood count were normal. EKG showed normal sinus rhythm with left ventricular hypertrophy and no ST changes. Urine drug screen was positive for cannabinoid only. Cardiac markers were negative. TSH was 0.01 mclU/mL (0.31-5.00 mclU/mL).Hospital Day 1: Chest x-ray showed a small density projecting over the right upper lung at the intersection of anterior 3 rd and posterior 6 th ribs. Follow up with CT pulmonary angiogram showed indeterminate homogenous solid mass within the anterior superior mediastinum along the aortic arch measuring approximately 5.5cm x 5.3cm x 2.4cm in craniocaudal, transverse and AP dimensions. Mass was not continuous with the thyroid and did not demonstrate cystic or calcified components [ Figures 1 and 2]. Thyromegaly without focal lesion was noted on CT imaging. Heart was normal in size without pericardial effusion and a collapsible Inferior vena cava [ Figure 3]. US thyroid revealed bilateral Thyromegaly with hypervascularity and no discrete nodules. Hospital Day 2:Due to suspicion for possible lymphoma or thymoma, Interventional radiology and Oncology were consulted to obtain biopsy of anterior mediastinal mass for further evaluation [ Figure 4].Shortly after returning from CT guided-needle biopsy of mediastinal mass, the patient developed nausea, profuse vomiting and became unresponsive. Upon arrival of Rapid Response Team, vital signs were heart rate 150, blood pressure 65/50 mmHg, RR 20, SpO2 95% on 6 L Oxygen. EKG showed sinus tachycardia without ST changes. Patient was given 1 L normal saline bolus and packed red blood cells were emergently prepared given concern for pulmonary artery injury as complication of biopsy. Bedside Ultrasound revealed pericardial effusion, non-collapsible inferior vena cava, and ventricular interdependence demonstrating tamponade physiology . Patient was intubated for airway protection and cardiothoracic surgery was emergently consulted for pericardiocentesis and evacuation of suspected mediastinal hematoma.Chest x-ray confirmed significant mediastinal widening suspicious for mediastinal hematoma [ Figure 8].Review of laboratory studies once patient was transferred to Intensive Care Unit showed TSH 0.01 mclU/mL (0.31-5.00 mclU/mL) with reflex Free T4 > 4.2 ng/dL (0.7-1.7 ng/dL) and T3 > 651 (71-170ng/ dL).Acetylcholine Receptor Binding Antibody was negative. BurchWartofsky score > 45, classifying patient as having Thyroid Storm.Emergent exploratory median sternotomy was perform...

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Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results.

Abstract: Artificial widening of the extrapleural space provides an access route to the anterior and posterior mediastinum for large-bore biopsy.

Cited by 46 publications

References 0 publications

Imaging guided thoracic interventions

Imaging guided thoracic interventions

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection—a safe and technically easy approach

A rare complication of mediastinal mass biopsy

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