CT guided lung biopsy: avoid fissures
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.
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The steps of the biopsy:
1. Surface markers to review lesion and plan approach
2. Co-axial needle in position before pleural breech (check course remains ideal)
3. Co-axial needle position prior to taking the biopsy
** the red arrows indicate the oblique fissure at the site of most appealing place to biopsy - hence this was avoided and the core was taken higher at the apex.
4. Post biopsy pneumothorax check.
This case is to illustrate some of the technical aspects of CT guided lung biopsy:
1. Perform only with a good clinical indication
2. Spend time to study and make your own opinion of the diagnostic scan prior to biopsy
3. 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.
4. Check on table before leaving if any pneumothorax post procedure.