CT-guided focal renal lesion biopsy

Case contributed by Dr Ian Bickle

Presentation

This chronic renal impairment patient underwent an ultrasound due to deterioriating creatinine levels. A 'solid' right upper pole mass was described.

Patient Data

Age: 69
Gender: Male
Modality: CT

A round mass isodense to the kidney is apparent at the extreme upper pole of the right kidney.

Note the intervening lung in the prone position making biopsy of the larger superior element not feasible.

Prior review with ultrasound was undertaken - it was not amenable to ultrasound guided biopsy.

Modality: CT

The initial route of the biopsy is shown with the 18G co-axial needle.

This is an important step in the biopsy allowing a check of the path, any patient movement of intervening structures prior to proceeding further to biopsy.

Modality: CT

The co-axial needle is 'parked' in front of the mass prior to biopsy.

TIP: Manually window the images to give the very best insight into the position of the needle tip.

Case Discussion

Image-guided percutaneous renal biopsy may be targeted or non-targeted (i.e. non-focal) and may be performed under ultrasound or CT guidance.

In this case, the biopsy proved the solid renal mass was a papillary cystic renal cell carcinoma on histopathology.

TIP: Always be aware of the potential for pneumothorax when performing an intervention on the upper pole of the kidney.

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Case Information

rID: 30958
Case created: 11th Sep 2014
Last edited: 9th Sep 2015
Inclusion in quiz mode: Included

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