CT-guided lung biopsy: pseudomalignancy

Case contributed by Dr Ian Bickle

Presentation

Cough and lethargy. Lung mass?

Patient Data

Age: 60 years
Gender: Male

Large lobulated mass in the right lower lobe extending to the pleural surface.  No intralesional calcification.

No pleural thickening.

The background lung parenchyma is normal.

Prone position.

Surface markers to plan biopsy approach.

Stages of biopsy using a co-axial needle set.

Small post procedural pneumothorax on check images post biopsy.

Case Discussion

Not every mass in the lung is a malignancy.

You would have your money on this being one by its size and appearance.   An initial FNAC did not identify any malignant cells.

On follow up imaging it remained and a core biopsy (two 20G cores) was taken.

It too did not identify malignancy, merely reported as inflammatory cells.  No malignant cells.  Histological conclusion: Scar tissue

Couple of CT lung biopsy tips.

a.  Thin pneumothoraces developing post procedure are common.  

Half fill a syringe with saline and aspirate the pneumothorax with the co-axial needle prior to withdrawal.  The air will bubble in the saline.  Stop aspirating when the bubbling stops.

2.  Window manually for needle tip positions throughout.

Notice the difference on the mediastinal and manually windowed 'lung' windows in the procedural steps.

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Case information

rID: 59792
Published: 26th Apr 2018
Last edited: 26th Apr 2018
Tag: ripas2
Inclusion in quiz mode: Included

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