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CT-Guided Transthoracic Needle Biopsy Using an Ipsilateral Dependent Position

¹ Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467-2490.
² Department of Radiology, New York Medical College and Westchester Medical Center, Valhalla, NY 10595.

View larger version (121K): [in a new window]   Fig. 1A. —54-year-old woman with squamous cell carcinoma in right lower lobe. CT scan obtained before biopsy with patient prone reveals right lower lobe mass 3 cm deep from pleural surface. Mass extends through major fissure into middle lobe that contains extensive bronchiectasis.

View larger version (146K): [in a new window]   Fig. 1B. —54-year-old woman with squamous cell carcinoma in right lower lobe. CT scan obtained during fine-needle biopsy with patient in 90° ipsilateral dependent position shows that lesion has shifted to more cephalad position because of elevation of diaphragm. Lesion is only 1 cm deep from posterior pleura. Directional needle (arrow) has been placed superficially to pleura. Biopsy needle (arrowhead) is in lesion; entry point (not shown) was made slightly lower.

View larger version (111K): [in a new window]   Fig. 2A. —57-year-old man with poorly differentiated small cell carcinoma. CT scan obtained with patient supine shows anterior mediastinal lymphadenopathy that is separated from chest wall by aerated lung.

View larger version (124K): [in a new window]   Fig. 2B. —57-year-old man with poorly differentiated small cell carcinoma. CT scan obtained during biopsy with patient in ipsilateral dependent position with slight posterior obliquity shows that mediastinum has shifted, allowing extrapleural pathway. Needle was passed along sternum without pleural transgression and medial to internal thoracic vessels (arrow).

View larger version (103K): [in a new window]   Fig. 3A. —67-year-old man with adenocarcinoma in left lower lobe. CT scan obtained during fine-needle biopsy at outside institution with patient prone shows small pneumothorax despite subpleural location of lesion. Single 20-gauge needle pass resulted in nondiagnostic specimen.

View larger version (110K): [in a new window]   Fig. 3B. —67-year-old man with adenocarcinoma in left lower lobe. CT scan obtained 10 days later during coaxial core needle biopsy, with patient in approximately 40° ipsilateral dependent position, shows tip of guiding cannula at surface of lesion; guiding cannula may or may not have crossed parietal pleura. Multiple passes yielded diagnostic material without complications. Although oblique rather than 90° ipsilateral dependent position was necessary to approach this posterolateral lesion, dependent lung remained hypoinflated and partially immobilized.

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