CT guided lung biopsy - deep transpectoral

Case contributed by Dr Ian Bickle

Presentation

Suspicious right upper lobe mass. Concern over malignancy. Biopsy requested.

Patient Data

Age: 40 years
Gender: Male

Large spiculated right upper lobe mass.

Surface markers applied.

Anterior transpectoral route.

No post procedural pneumothorax or perilesional haemorrhage.

Annotated image

Stepwise summary of the steps in a CT guided lung biopsy.

Case Discussion

Planning the approach for lung biopsy carefully is vital.

A big mass doesn't always mean an easy biopsy.

Prone (oblique fissure and ribs) and lateral (axillary vessels) approaches in this case have obstructing structures.

An anterior appears best, but it is a deep transpectoral muscle biopsy, traversing a lot of lung.

The two main potential complications are:

  1. pneumothorax
  2. haemoptysis

This biopsy required all 11cm of the co-axial needle to reached the mass.  A single pass and single core was taken.

In this case, the patient had post-procedural haemoptysis (5-10mls) which self-resolved.

Life lesson - even when a procedure is performed to plan it doesn't mean it will be free of complications.

HISTOLOGY:   Adenocarcinoma of the lung

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Case information

rID: 51029
Case created: 2nd Feb 2017
Last edited: 7th Feb 2017
Inclusion in quiz mode: Excluded

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