Diagnostic ultrasound ( PDFDrive )

608 PART II Abdominal and Pelvic Sonography
A
B
FIG. 17.9 Ultrasound-Guided Biopsy of Adrenal Mass. (A) CT scan without contrast demonstrates a 2-cm mass in the right adrenal gland.
(B) Longitudinal ultrasound image shows value of the liver as a biopsy path to the right adrenal gland.
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B
FIG. 17.10 Ultrasound-Guided Biopsy of Melanoma Metastasis to the Spleen. (A) Contrast-enhanced CT shows a 4-cm mass in the spleen.
(B) Transverse ultrasound demonstrates the 18-gauge biopsy needle within the mass.
who would otherwise have diiculty cooperating, and (4) absence
of ionizing radiation. 103 Ultrasound biopsy of mediastinal masses
can be performed if the mass is visible. Mediastinal vessels in
the path of the needle may be avoided with the use of color
Doppler ultrasound before needle placement.
Complications
Image-guided percutaneous needle biopsy is a widely accepted
mode of obtaining tissue for diagnosis, in part because of its
well-documented safety. Several large reviews using multiinstitutional
questionnaires have reported major complication
rates of 0.05% to 0.5% and mortality rates of 0.008% to
0.038%. 16,24,70,104-106
Although rare, hemorrhage is the most common major
complication of solid-organ biopsy and accounts for most biopsyassociated
deaths. If hemorrhage is suspected ater biopsy and
the patient is hemodynamically stable, CT should be obtained.
CT is more accurate than ultrasound to evaluate for hemorrhage. 82
On ultrasound, fresh blood has an echogenicity similar to that
of surrounding tissues and can be overlooked (Fig. 17.12).
he diference in the complication rates associated with the
use of larger-caliber core biopsy needles and small-caliber needles