Diagnostic ultrasound ( PDFDrive )

1952 PART V Pediatric Sonography
RT OBL
RT OBL
* * * *
A
B
*
*
*
*
*
*
C
FIG. 56.9 Ultrasound-Guided Deep Local Anesthetic Application
During Liver Biopsy. (A) A 30-gauge needle (white arrows)
is inserted onto the liver capsule (black arrows). (B) Needle (white
arrows) administering deep local anesthetic (black *) onto the
liver capsule under ultrasound control. (C) Liver biopsy device
inserted through the residual local anesthetic (white *), which
had anesthetized the liver capsule, where most of the pain sensation
arises.
reports and other clinical data make this easy. he interventional
radiologist is responsible for having a clear understanding of
the clinical reasons for the procedure and the expected beneits.
At times, it is the duty of the interventional radiologist to insist
on, or convene, a combined-care conference before undertaking
a major procedure. his can be the greatest contribution a
radiologist can make to the medical care of the child.
Coagulation Studies
Hematologic management in the patient undergoing percutaneous
image-guided intervention is complex because of the wide range
of procedures and equally wide range of patient demographics
and comorbidities. Coagulation studies are indicated for most
intraabdominal, chest wall, or retroperitoneal abscess drainage
or biopsy procedures, which carry a moderate risk of bleeding;
it should also be noted that renal biopsy carries a signiicant
bleeding risk. 11 he management guidelines recommend correcting
the international normalized ratio (INR) to below 1.5. 12 A platelet
count is usually obtained in oncology patients; underlying
malignancy appears to be an independent risk factor for bleeding
ater liver biopsy. 13 Caution should be exercised when the platelet
count is below 50,000, and it is important to remember that
platelet function may be afected by some chemotherapy, by
nonsteroidal antiinlammatory agents, by uremia, and by other
medical conditions. Patients with Wilms tumor may rarely have
an undiagnosed transient acquired von Willebrand syndrome.
Caution should be exercised if the skin incision continues
to bleed vigorously for more than a minute or so. It is better to
cancel a procedure and do a full coagulation workup than to
continue and cause a major hemorrhage.
Aims and Expectations
Anticipation of problems is good practice, not a sign of weakness.
No procedure should be undertaken without a clear understanding