CT guided para-aortic lymph node biopsy

Case contributed by Dr Ian Bickle

Presentation

TIssue diagnosis required for patient management.

Patient Data

Age: 50 years
Gender: Female
Ultrasound

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;

- favorable for lesions requiring a prone position for the approach

- favorable 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

 

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