IS Case 270: Pleura sparing mediastinal mass biopsy
Imaging Sciences URMC 2009
Publication Date: 2009-07-29
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.
- Bressler EL, Kirkham JA. Mediastinal masses: alternative approaches to CT-guided needle biopsy. Radiology. 1994 May;191(2):391-6. PMID: 8153311 [PubMed]