IS Case 270: Pleura sparing mediastinal mass biopsy

Devang Butani, MD


Imaging Sciences URMC 2009
Publication Date: 2009-07-29

History

Patient is a 24-year-old female with chest pain and anterior mediastinal mass.

Findings

A large anterior mediastinal soft tissue mass was seen on initial CT and a biopsy was requested

Diagnosis

Pleura sparing mediastinal mass biopsy

Discussion

Multiple approaches can be used to biopsy lesions in the chest and mediastinum. The risk of pneumothorax is reported to be as high as 20%, based on large studies. Anterior mediastinal masses, if large enough, can be biopsied without violating the pleura, and pneumothorax can be avoided.

In this case, we placed a co-axial needle under CT fluoroscopy via an anterior approach. The mass displaces lung and pleura laterally, and this is where the mass was accessed. While traversing the para-sternal region, the internal mammary artery should be avoided. Once the needle is in the mass, the stylet is removed and multiple core samples can be obtained using a standard biopsy gun. The co-axial system is removed and post-procedure scan is obtained to rule out pneumothorax.

References

  1. Bressler EL, Kirkham JA. Mediastinal masses: alternative approaches to CT-guided needle biopsy. Radiology. 1994 May;191(2):391-6. PMID: 8153311 [PubMed]

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