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Combined Sonographic and Fluoroscopic Guidance During Transjugular Hepatic Biopsies Performed in Children: A Retrospective Study of 74 Biopsies

Krzysztof Habdank1, Ricardo Restrepo1, Vicky Ng2, Bairbre L. Connolly1, Michael J. Temple1, Joao Amaral1 and Peter G. Chait1

1 Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada.
2 Department of Gastroenterology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.



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  		Fig. 1. —14-year-old girl with fulminant hepatic failure. Wedge venogram obtained via right hepatic vein (arrow) shows parenchymal stain and hepatofugal flow from portal vein (arrowheads).

 


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  		Fig. 2A. —7-year-old girl with graft-versus-host disease. Sagittal sonogram of liver clearly depicts stiffening cannula (arrowhead). Note that if biopsy had been performed from this position, gallbladder (arrow) would have been punctured.

 


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  		Fig. 2B. —7-year-old girl with graft-versus-host disease. Sagittal sonogram acquired at same level as A after repositioning needle (arrowhead) away from gallbladder (arrow). Expected pathway of needle (calipers) can be measured (2.2 cm).

 


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  		Fig. 3. —10-year-old boy with Wilson's disease. Fluoroscopic image obtained after biopsy needle was fired does not reveal exact location of needle tip.

 


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  		Fig. 4. —5-month-old boy with coagulopathy and undiagnosed metabolic disease. Subtracted image of venogram obtained using left internal jugular approach shows right internal jugular central venous line (arrow) and middle hepatic vein (arrowhead) where biopsy was performed.

 

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