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Transjugular Biopsy of the Liver in Pediatric and Adult Patients Using an 18-Gauge Automated Core Biopsy Needle: A Retrospective Review of 410 Consecutive Procedures

Tony P. Smith1, Thomas L. Presson1,2, Michael A. Heneghan1,3 and J. Mark Ryan1

1 Department of Radiology, Rm. 1502, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Present address: Wake Radiology Consultants, 3614 Haworth Dr., Raleigh, NC 27609.
3 Department of Medicine, Duke University Medical Center, Box 3808, Durham, NC 27710.



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  		Fig. 1A. —60-year-old woman whose clinical indication for liver biopsy was increasing value of results from liver function tests. Patient had undergone orthotopic liver transplantation 13 years earlier. Venogram of middle hepatic vein (arrows) shows normal flow in vein but acute angulation of vein to inferior vena cava (arrowhead), which precluded safe placement of stainless steel trocar and sheath in vein for biopsy.

 


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  		Fig. 1B. —60-year-old woman whose clinical indication for liver biopsy was increasing value of results from liver function tests. Patient had undergone orthotopic liver transplantation 13 years earlier. Venogram obtained after catheter was repositioned into smaller branch (arrows) of middle hepatic vein. Repositioning resulted in better angle between inferior vena cava and middle hepatic vein, allowing stainless steel trocar and sheath (arrowhead) to be safely placed into vein for biopsy procedure.

 


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  		Fig. 1C. —60-year-old woman whose clinical indication for liver biopsy was increasing value of results from liver function tests. Patient had undergone orthotopic liver transplantation 13 years earlier. Venogram shows automated core biopsy needle during transjugular biopsy of the liver. Image was obtained just before outer cutting canula was fired over slotted stylet (arrows) to obtain biopsy core specimen. Four needle passes were required in this patient to obtain adequate amount of tissue.

 

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