Ultrasound-guided lung nodule biopsy

Case contributed by Dr Michael P Hartung

Presentation

Incidental lung mass detected on imaging, for further evaluation.

Patient Data

Age: 70
Gender: Male

Lobulated right middle lobe nodules which has broad contact with the anterior pleura. 

Ultrasound-guided biopsy

Planning and annotated images showing the relevant anatomy and technique for biopsy. See discussion for greater details. 

Case Discussion

Many people think that CT or bronchoscopy are the only two options for lung biopsy, but ultrasound is a wonderful option for nodules with pleural contact. 

I prefer to do lung biopsies with ultrasound whenever possible. The advantages:

  • mid/lower lung nodules tend to move more with breathing; ultrasound allows the operator to dynamically follow and adjust trajectory based on variations in breathing/breath hold
  • peripheral nodules such as this would actually be pretty hard to target with CT biopsy; it will move a lot with breathing, and it is hard to be confident that the needle is in the nodule 1-2 mm before firing the biopsy device to avoid firing through the pleura and increasing the risk of pneumothorax
  • the anatomy can be quite well seen as shown in the annotated images and post procedural pneumothorax can also be detected

For this case, I performed a single 1.2 cm throw using a 18 gauge Biopince biopsy device using a transducer guide. I advanced the needle into the mid/distal depth of the nodule, and withdrew it until I was about 2 mm deep from the pleural interface before firing. Only one sample was obtained because the core was complete and white (indicating pathologic tissue), and the final pathology was poorly differentiated squamous cell carcinoma. Very small amount of air leaking from the tract and the patient was immediately placed lying on the right side to compress it against the body wall. No pneumothorax on 1 hr radiograph. 

PlayAdd to Share

Case information

rID: 75440
Published: 29th Mar 2020
Last edited: 29th Mar 2020
System: Chest
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.