Presentation
TIssue diagnosis required for patient management.
Patient Data
Pathological nodes at the splenic hilum. Inaccessible for biopsy.
3cm left para-aortic node. Deep position and technically challenging under ultrasound control to biopsy.
The most amenable and safest site for a tissue biopsy is the left para-aortic nodes.
Co-axial needle approach in the left paraspinal region. Co-axial needle in situ prior to core biopsy acquisition.
Case Discussion
The co-axial needle approach allows for the gradual, safe and secure positioning of the needle in relation to a lesion prior to biopsy acquisition and the facility to take multiple cores.
Key aspects for CT biopsy;
- favourable for lesions requiring a prone position for the approach
- favourable for deep locations
- enables a secure position when close to key structures (in this case the renal vessels anterior to the node)
- remember you have no contrast to help when undertaking the biopsy unlike on the diagnostic scan
- flip the prone images when planning so one can best appreciate the relation to other structures on the diagnostic contrast enhanced study