CT guided lung biopsy: deep location

Case contributed by Dr Ian Bickle

Presentation

Lung mass on diagnostic scan. Non-smoker. Cancer?

Patient Data

Age: 80
Gender: Female

Spiculated deeply sited right upper lobe mass

No straightforward short route for biopsy.

Prone approach traversing nearly 5cm of lung and avoiding posteriorly sited vessels.

No immediate post procedural pneumothorax or pulmonary haemorrhage.

Case Discussion

This is an example of a deep sited CT guided lung biopsy.  A large amount of lung required to be traversed to access the lesion with the additional risk of biopsy that this presents.

A good example of where time dedicated to planning approach worth the investment prior to the procedure.

1.  What is the best/easiest/safest route?

Anterior approach not appealing - especially in a female with breast tissue.

2.  Lateral approach ?

Deep route to the lesion and also the difficulties of the ribs to avoid.   Positioning the patient in the lateral position also can be harder to maintain a still and stable position.

3. Prone?

An appealing unobstructed route, but a lot of lung to traverse en route.  Also some prominent vessels posteriorly close to the mass to avoid on the medial aspect.

The procedure was undertaken without complication.

Diagnosis:  Adenocarcinoma

 

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Case information

rID: 49415
Case created: 23rd Nov 2016
Last edited: 28th Nov 2016
Inclusion in quiz mode: Excluded

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