CT guided acetabular biopsy

Case contributed by Dr Ian Bickle

Presentation

Pain in right hip and unable to weight bear whilst on holiday overseas. Prior nephrectomy for RCC.

Patient Data

Age: 70 years
Gender: Male
CT

The right acetabulum is largely replaced by a destructive lytic lesion with extensive cortical destruction, most pronounced on the posterior wall of the acetabulum.

Associated pathological fracture extending into the acetabular roof.

No other focal bone lesion.

CT

The step wise approach to approaching the acetabular lesion for biopsy.

Initial approach and needle identification.

Note the glare from the needle on soft tissue windows.

Co-axial needle advanced along the plane to the edge of the bone lesion.

On bone window the needle tip position is much better shown.

Case Discussion

Pathological acetabular fracture from in a patient with prior renal cell carcinoma (RCC).

RCC is notorious for destructive bony metastases.

Due to the fracture the patient was unable to lie prone to access the acetabular lesion for biopsy.  It was therefore performed in the lateral position.

The step wise approach to biopsy is illustrated.

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Case information

rID: 51869
Published: 22nd Mar 2017
Last edited: 24th Mar 2018
Inclusion in quiz mode: Excluded

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