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ABDOMINAL ULTRASOUND
RT
Figure 11.5 In a liver full of metastases, the electronic
pathway is lined up on a hyperechoic lesion near the
surface (arrows).
Figure 11.6 The needle is introduced into the liver, just
in front of the lesion, and the gun is fired, propelling the
needle tip into the chosen lesion (arrows).
presence/absence of parenchymal liver disease,
severity of disease and, where appropriate, the
aetiology of the disease process. This is often performed
in patients with abnormal liver function
tests with no evidence of biliary obstruction. The
Figure 11.7 A focal liver lesion immediately post-biopsy,
two passes. Residual air is noted within the lesion
outlining the recent biopsy tracks. This is a very useful
appearance and visually confirms that the biopsy has
been taken from the correct area.
clinical history and serological analysis can be
helpful in determining aetiology; however biopsy
is often required. This is normally performed
with a 14G or 16G Tru-Cut needle. Very often
the liver is simply identified with ultrasound and
a suitable mark made on the skin, often in the
mid-axillary line, and the biopsy performed
through the right lobe. Although this is acceptable
for this type of biopsy, as no guidance is
required towards a specific focal lesion, ultrasound
guidance during the procedure is still
preferable to the ‘blind’ technique in order to
avoid large vessels and reduce the subsequent risk
of haematoma. Biopsy may also be performed for
patients with suspected rejection following
hepatic transplantation.
Where coagulation profiles are not correctable
(and most generally are), liver biopsy can be performed
using a ‘plugged’ technique or, more commonly,
by the transjugular route (Fig. 11.8).
Pancreatic biopsy
The commonest reason for biopsy of the pancreas
is in patients presenting with obstructive jaundice
due to a mass in the head of the gland. A fineneedle
technique enables the mass to be accessed
through the stomach and left lobe of liver without