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Value of "Patent Track" Sign on Doppler Sonography After Percutaneous Liver Biopsy in Detection of Postbiopsy Bleeding: A Prospective Study in 352 Patients

Kyoung Won Kim1, Min-Jeong Kim1,2, Hyo-Cheol Kim3, Seong Ho Park1, So Yeon Kim1, Mi-Suk Park1,4 and Tae Kyoung Kim1,5

1 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-ku, Seoul 138-736, Korea.
2 Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.
3 Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
4 Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
5 Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada.


Figure 1
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  		Fig. 1A —48-year-old man with "patent track" sign on Doppler sonography after percutaneous liver biopsy. Gray-scale sonogram obtained immediately after biopsy needle withdrawal shows echogenic linear track along needle path (arrowheads).

 

Figure 2
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  		Fig. 1B —48-year-old man with "patent track" sign on Doppler sonography after percutaneous liver biopsy. Duplex color Doppler sonogram shows linear color-flow signal toward liver capsule along needle track (arrows), defined as patent track sign, and pulsatile arterial waveform in track.

 

Figure 3
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  		Fig. 2A —47-year-old man with bleeding after percutaneous liver biopsy. Gray-scale sonogram obtained immediately after biopsy needle withdrawal shows echogenic linear track along needle path (arrowheads).

 

Figure 4
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  		Fig. 2B —47-year-old man with bleeding after percutaneous liver biopsy. Color Doppler sonogram shows "patent track" sign (arrows).

 

Figure 5
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  		Fig. 2C —47-year-old man with bleeding after percutaneous liver biopsy. Axial CT scan shows large amount of intraperitoneal hematoma and active extravasation of IV contrast agent from biopsy entry site of liver (arrowheads).

 

Figure 6
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  		Fig. 2D —47-year-old man with bleeding after percutaneous liver biopsy. Hepatic arteriogram also shows active extravasation from hepatic artery (arrowhead). Patient underwent prompt surgical hemostasis and improved.

 

Figure 7
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  		Fig. 3A —44-year-old man with bleeding after percutaneous liver biopsy. Color Doppler sonogram obtained 5 minutes after percutaneous liver biopsy shows persistent "patent track" sign (long arrows). Sonogram also shows low-echoic hematoma in abdominal wall (arrowheads) and small amount of perihepatic free fluid (short arrows).

 

Figure 8
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  		Fig. 3B —44-year-old man with bleeding after percutaneous liver biopsy. Duplex color Doppler sonogram reveals pulsatile arterial waveform in track.

 

Figure 9
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  		Fig. 3C —44-year-old man with bleeding after percutaneous liver biopsy. Axial CT scan obtained 2 days after embolization shows persistent extravasation of IV contrast agent from biopsy entry site (arrowheads). Patient underwent surgical hemostasis and improved.

 

Figure 10
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  		Fig. 4A —60-year-old man with bleeding after percutaneous liver biopsy. Duplex color Doppler sonogram obtained immediately after biopsy procedure shows "patent track" sign (arrow) and monophasic venous waveform in track.

 

Figure 11
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  		Fig. 4B —60-year-old man with bleeding after percutaneous liver biopsy. Color Doppler sonogram obtained at 5 minutes after biopsy shows anechoic intrahepatic hematoma (long arrows) and small amount of subhepatic fluid (short arrows) as well, suggestive of intraperitoneal hemorrhage.

 

Figure 12
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  		Fig. 4C —60-year-old man with bleeding after percutaneous liver biopsy. Axial CT scan obtained 2 days after biopsy shows profuse intrahepatic hematoma as well as intraperitoneal hematoma in subhepatic space. Patient improved with conservative medical management consisting of close clinical monitoring and continuous transfusion.

 

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