Diagnostic ultrasound ( PDFDrive )

CHAPTER
17
Ultrasound-Guided Biopsy of Chest,
Abdomen, and Pelvis
Theodora A. Potretzke, Thomas D. Atwell, J. William Charboneau, and Carl Reading
SUMMARY OF KEY POINTS
• Ultrasound is a key method of guidance for biopsy and
luid drainage because of its real-time needle visualization
and the ability to image and intervene in multiple anatomic
locations and planes.
• Effective periprocedural antithrombotic management
requires an understanding of speciic antithrombotic
agents as well as the balance of the potential risk of
hemorrhage from a given procedure versus the risk of a
thrombotic event if a blood thinner is discontinued.
• Ultrasound typically offers excellent guidance for
supericial biopsies, paracentesis, thoracentesis, and most
solid organ biopsies in the abdomen including liver, kidney,
and spleen. CT guidance is often utilized for adrenal,
retroperitoneal, and certain deep pelvic biopsies or deep
drain placement.
• Familiarity with both trocar and Seldinger techniques is
useful for ultrasound-guided drain placement.
CHAPTER OUTLINE
PERCUTANEOUS NEEDLE BIOPSY
Indications and Contraindications
Periprocedural Antithrombotic
Management
Imaging Methods
Ultrasound
Computed Tomography
Needle Selection
Biopsy Procedure
Needle Visualization
Speciic Anatomic Applications
Liver
Pancreas
Kidney
Adrenal Gland
Spleen
Lung
Complications
ULTRASOUND-GUIDED DRAINAGE
Indications and Contraindications
Imaging Methods
Catheter Selection
Patient Preparation
Diagnostic Aspiration
Catheter Placement
Drainage Procedure
Follow-Up Care
Catheter Removal
Abdominal and Pelvic Abscesses:
General
Speciic Anatomic Applications
Liver
Biliary Tract
Pancreas
Spleen
Kidney
PERCUTANEOUS CYST
MANAGEMENT
Renal Cyst
Liver Cyst
Ovarian Cyst
Percutaneous biopsy and luid drainage are invaluable diagnostic
and therapeutic procedures for the management of
patients. Ultrasound is a central method of guidance for these
interventional techniques because it allows real-time needle
visualization and the ability to image and intervene in multiple
anatomic locations and planes. An approach to this topic requires
knowledge of the current fundamental methods and applications
of these procedures in general and in terms of speciic anatomic
locations.
PERCUTANEOUS NEEDLE BIOPSY
Because of its relatively low cost and wide availability,
ultrasound-guided biopsy has become one of the most important
methods of tissue diagnosis in radiology practices worldwide.
Ultrasound-guided biopsy is a safe and accurate technique for
conirmation of suspected malignant masses and characterization
of benign lesions in locations throughout the body. 1,2 In addition,
minimally invasive tissue conirmation decreases patient costs
by obviating the need for a surgical diagnosis and decreasing
duration of hospital stay and number of ancillary diagnostic tests.
In addition, lack of ionizing radiation and real-time imaging
during the procedure make the procedure safer.
Indications and Contraindications
In most cases a biopsy is performed in the setting of possible
malignancy, for either initial diagnosis of cancer, conirmation
of metastatic disease, or to obtain tissue for molecular proiling
and targeted treatment planning. In other patients, biopsy is
performed to gauge the presence of parenchymal disease in a
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