CT guided lung biopsy - the importance of avoiding fissures

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Young patient with embolic occipital lobe infarcts. Incidental chest x-ray finding leading to CT chest, which revealed a right apical mass. TB markers negative.

Patient Data

Age: 35 years
Gender: Female
This study is a stack
Axial
non-contrast
This study is a stack
Axial lung
window
Axial lung
window
This study is a stack
Axial lung
window
This study is a stack
Axial lung
window
This study is a stack
Axial
non-contrast
This study is a stack
Axial lung
window
Show annotations
Download
Info

The steps of the biopsy:

1. surface markers to review the target lesion and plan approach - note the oblique fissure at the site of the most appealing place to biopsy - hence this was avoided and the core was taken higher at the apex

2. co-axial needle in position before pleural breech (check course remains ideal)

3. pre-biopsy co-axial needle position

4.  post-biopsy pneumothorax check (no pneumothorax is present)

Case Discussion

This case is to illustrate some key technical aspects of a CT guided lung biopsy:

  • perform only with a good clinical indication

  • spend time to study and make your own opinion of the diagnostic scan before biopsy

  • avoid traversing fissures, as this increases pneumothorax risk

    • in this case, an easier route to a larger part of the mass is tempting, but this would traverse the oblique fissure

  • perform post procedure on table imaging to see if there is any pneumothorax post-procedure

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.