经皮肺穿刺活检注射生理盐水与凝血酶预防常见并发症的对比

目的：对比使用生理盐水与凝血酶在经皮肺穿刺活检术中预防常见并发症的效果。方法：回顾性分析注射生理盐水和凝血酶在CT引导下经皮肺穿刺活检且年龄≥55岁的连续病例资料各50例,A组注射生理盐水,B组注射凝血酶。对比两组患者注射液体的分布情况和常见并发症的发生率。结果：100例均穿刺成功。A组患者液体沿穿刺针道分布较广、甚至呈斑片状;B组患者液体基本沿穿刺针道呈线状分布。A组发生气胸4例,肺出血8例;B组气胸3例,肺出血2例。结论：注射凝血酶在预防经皮肺穿刺活检常见并发症方面较注射生理盐水更有效。     

Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.     

应用生理盐水预防经皮肺穿刺活检中气胸发生的初探

目的：探讨在经皮肺穿刺活检术中应用生理盐水预防气胸发生的效果。方法：经皮肺穿刺活检病例136例,其中年龄〈55岁36例,年龄〉55岁100例（随机分成A、B两组,各50例）,其中B组在经皮肺穿刺活检术中经穿刺针注射生理盐水。结果：136例均穿刺成功,并发气胸的情况：年龄〈55岁组发生气胸2例,气胸量〈10%。年龄大于55岁的气胸发生率较高,A组发生气胸14例,其中12例气胸量〈10%、2例〉30%,有皮下气肿1例;B组发生气胸4例,气胸量均〈10%。B组的气胸发生率明显低于A组,B组无1例因注射生理盐水而出现咳嗽、咳痰等不适。结论：经皮肺穿刺活检术中注射生理盐水可在一定程度上堵塞穿刺针穿刺肺胸膜的针孔道,减少气胸的发生率。     

CT引导下穿刺活检及介入治疗的临床应用(附56例分析)

目的：探讨ＣＴ引导下穿刺活检及介入治疗的临床应用价值。方法：ＣＴ引导下行诊断目的２９例,治疗目的１７例,诊断及治疗双目的的１０例病人。穿刺部位包括胸部１７例,腹部２７例,躯干及四肢１２例,共５６例６０个病灶。ＣＴ扫描确定穿刺点、角度及深度。局麻进针后,ＣＴ再次扫描确认针尖到达预定位置再进行活检取材或介入治疗。结果：６０ 个病灶穿刺６１针次,穿刺一次成功率１００％ ,确诊率９７．４％ ,治疗有效率８８．９％ ,并发症５．４％ 。结论：ＣＴ引导下穿刺活检及介入治疗属微创伤性技术,简便易行,安全有效,成功率高,并发症少。     

Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy

CT-guided transthoracic lung biopsy is becoming a widely accepted procedure for the diagnosis of pulmonary lesions. The rate of severe complications following such a procedure has been reported. Of these complications, air embolism is the most likely to be fatal. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung. The patient died from underlying malignant disease 4 months later.Coronary artery air embolism, a condition with a high mortality rate, mostly results from the iatrogenic introduction of gas bubbles into the bloodstream. Direct injection of air or gas into major arterial vessels during cardiac catheterisation or interventional radiological angiography has been reported; however, it also is a rare complication of CT-guided percutaneous transthoracic biopsy of the lung. In the literature, 19 possible causes for air embolism are listed [1]. Of these, two are generally accepted as the most probable causes: communication of the ambient air with a pulmonary vein via the biopsy needle, or development of a bronchial-venous fistula at the needle tract or site of the core sample. We report a case of air embolism in the aorta and right coronary artery resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of lung.     

Efficacy of manual aspiration immediately after complicated pneumothorax in CT-guided lung biopsy

PURPOSE: The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax after computed tomography (CT)-guided lung biopsy. MATERIALS AND METHODS: This retrospective study was based on experience with 283 consecutive percutaneous needle lung biopsies with real-time CT fluoroscopic guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all those with moderate or large pneumothorax demonstrated on postbiopsy chest CT images regardless of symptoms. The authors evaluated the frequency of biopsy-induced pneumothorax, management of each such case, and factors that influenced the incidence of worsening pneumothorax that required chest tube placement despite manual aspiration. RESULTS: Of the 104 (36.7%) pneumothoraces occurring after 283 biopsy procedures, 52 were treated with manual aspiration immediately after biopsy. In 95 of the 104 pneumothoraces (91.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only nine patients (3.2% of the entire series; 8.7% of those who developed pneumothorax) required chest tube placement. Requirement of chest tube insertion significantly increased parallel to the increased volume of aspirated air. The optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 543 mL. CONCLUSION: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and eliminate the need for chest tube placement. However, in cases in which the amount of aspirated air is large (such as more than 543 mL in this study), the possibility of required chest tube placement increases.     

Liver transplant biopsies with a biopsy gun

The authors evaluated the safety and efficacy of a biopsy gun for performance of image-guided percutaneous biopsy of hepatic allografts in liver transplant recipients. Two hundred fifty-two liver biopsies were performed in 58 transplant recipients over a 27-month period by using this instrument with an 18-gauge needle. Major complications occurred in two of the 252 biopsies (0.8%): One hemopneumothorax necessitated drainage with a chest tube, and one hemorrhage necessitated transfusion. No patient required surgical exploration because of a complication of the biopsy. Specimens were adequate for accurate histopathologic diagnosis in 248 of 252 procedures (98.4%). The authors conclude that image-guided percutaneous biopsy of hepatic allografts with use of the biopsy gun is a safe and accurate method of obtaining hepatic tissue from liver transplant recipients for histopathologic analysis.     

CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures

PURPOSE: This study was performed to evaluate the factors affecting the diagnostic accuracy and rate of complications of CT-guided percutaneous transthoracic needle biopsy of mediastinal masses. MATERIALS AND METHODS: We reviewed 73 consecutive mediastinal biopsies in 70 patients. Final diagnoses were based on a retrospective analysis of surgical outcomes, results of repeat biopsies or findings of imaging and clinical follow-up lasting at least 4 months. Benign and malignant biopsy findings were compared with the final outcomes to determine the diagnostic accuracy of the method. Finally, we analysed the complications. RESULTS: CT-guided percutaneous transthoracic needle biopsy provided adequate samples in 61/73 cases, with a total sample rate of 83.6%. Of these 61 biopsies, 51 yielded a correct diagnosis with specific histological typing, mainly in the case of thymoma and metastasis. Lymphomas were less reliably diagnosed. The overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy values were 83.6%, 100%, 100%, 35.3% and 83.6%, respectively. Pneumothorax was the most common complication (5.5%). CONCLUSIONS: CT-guided percutaneous transthoracic needle biopsy is an easy, reliable and safe procedure that obviates the need for exploratory surgery in medically treatable or unresectable cases. It should be the first invasive procedure in the diagnostic workup of mediastinal masses.     

Compartmental anatomy relevant to biopsy planning

Although percutaneous needle biopsies are typically safe, there are possible musculoskeletal needle biopsy complications. Preoperative consultation with orthopaedic surgeons providing treatment is appropriate for radiologists performing percutaneous tumor biopsies because biopsy tracts need to be resected along with the specimens in cases of primary malignancy. Knowledge of compartmental anatomy may help avoid complications related to poorly planned or executed needle biopsies that may compromise the ability of the surgeon to perform a limb-sparing resection.     

CT引导经皮肺穿刺活检术(附53例报告)

目的:评价CT引导下经皮肺穿刺活检术的临床价值,并对并发症的发生、预防进行探讨.方法:对53例患者的55个肺部病灶进行CT引导下穿刺活栓,用COOK公司18G、21G活检针或活检枪进行病灶穿刺,穿刺后行细胞学,并对并发症进行分析.结果:55个病灶穿刺成功率100%,阳性率94%,敏感率94%,并发症发生率5%.结论:CT引导经皮肺穿刺活检术是一种安全可靠的检查方法,诊断准确率高.     

Percutaneous radiofrequency treatment of osteoid osteoma using cool-tip electrodes

OBJECTIVES: To report our experience with percutaneous cool-tip radiofrequency ablation of osteoid osteomas and to evaluate clinical outcome. METHODS AND MATERIAL: Forty-one patients with clinically and radiologically suspected osteoid osteoma were seen over a 48-month period (27 males and 14 females with a mean age of 18.7 years; range 5-43 years). Thirty-eight patients were treated by computed tomography (CT)-guided percutaneous radiofrequency ablation. The procedure was performed under regional or general anaesthesia. After location of the nidus, a 14G-bone biopsy needle is introduced into the nidus. Sampling is performed with a 17G-bone biopsy needle using a coaxial technique. The radiofrequency needle with a 10mm active tip (cool-tip) is inserted through the biopsy needle and is connected to the radiofrequency generator for 6-8 min. RESULTS: Primary success was obtained in 37 patients (97%) with a 100% secondary success rate. All patients are currently pain-free. No major complications occurred. Patients could resume unrestricted normal activity within 24 h. CONCLUSIONS: Percutaneous radiofrequency ablation of osteoid osteomas is an efficient and safe method that can be considered the procedure of choice for most cases.     

Acute Coronary Artery Air Embolism Following CT-Guided Lung Biopsy

CT-guided needle biopsy is a common procedure for obtaining a tissue diagnosis and consequently correctly managing patients. This procedure has many potential complications, ranging from simple pneumothorax or self-limiting hemoptysis to life-threatening pulmonary hemorrhage and air embolism. Though the latter is a rare complication of CT-guided needle biopsy, it has attracted a lot of interest. We report a case of right coronary air embolism resulting in myocardial infarction after a CT-guided percutaneous needle biopsy of the lung.     

X线导向经皮骨穿刺活检

目的:探讨X线导向经皮骨穿刺活检对骨病的诊断价值。材料和方法:骨穿刺活检79例,通过观察X线片及CT确定活检的最佳部位。在X线导向下进行多点和不同浓度的骨穿刺活检取材。结果:79例行骨穿刺活检82次,其中3例穿刺2次。76例穿刺活检结果能作出诊断,阳性率为96.2％。没有发生并发症。结论:本法的优点是适应症广、简单、安全、快速、可靠、经济,并发症少及缩短诊断时间。医生在穿刺活检过程中不受X线辐射,而病人只有短暂的透视定位。     

X线导向经皮胸部穿刺针吸活检(附401例报告)

目的：评价Ｘ线导向经皮穿刺针吸活检术对胸部病变的诊断价值。方法：对４０１例胸部肿块或结节进行了４５１人次Ｘ线导向经皮穿刺针吸活检术。结果：穿刺针吸标本细胞学或细菌学检查阳性３５６例（８８．８％），阴性４５例（１１．２％）。经手术病理、随访或治疗等证实，真正阳性３５６例，真正阴性４例，诊断正确率为８９．８％，假阴性４１例，误诊率为１０．２％。穿刺活检术后发生气胸４１例（１０．２％），少量咯血３３例（８．２％），无大出血或大量咯血者，亦无死亡病例。结论：Ｘ线导向经皮穿刺针吸活检对胸部肿块或结节是一种简单实用且比较安全的获取诊断资料的检查方法。     

超声引导下经皮18G粗针活检诊断肠道壁增厚病变的价值

目的:评价超声引导下经皮18G粗针活检肠壁病变的安全性、有效性及临床应用价值。材料和方法:在超声引导下,对11例肠壁病变行18G粗针多点穿刺活检,观察取材的满意率和并发症。结果:全部病例均取材满意,无并发症发生。结论:超声引导下肠壁病变的18G粗针穿刺活检安全,所取标本较大、较完整,有利作出明确的病理学诊断,尤其适合于无法用消化内镜活检的小肠病变。     

CT引导下活检枪切割针肺活检的操作技术分析

目的探讨CT引导下活检枪切割针肺活检的操作技术要领和应用价值。资料与方法应用Bard Magnum Biopsy System活检枪及配套活检针,对72例肺部疾病患者行CT引导下肺活检。观察进针成功率、阳性诊断率、确诊率、并发症等,总结穿刺操作技术细节要领。结果一次进针成功率65％,阳性诊断率97％,确诊率89％,无须治疗的轻微并发症65％。平静呼吸下定位和穿刺、“优先4角度”定向、“三点一线”麻醉技巧、“三段进针”和“两快一慢”穿刺技巧是穿刺成功的重要操作技术要领。结论熟练掌握操作技巧,CT引导下活检枪切割针肺活检安全有效、简便易行、具有较大的临床实用价值。     

CT引导下经皮肺穿刺活检并发症的相关因素分析

目的:分析引起CT引导下经皮肺穿刺活检并发症发生的相关因素.方法:选取2003年10月～2005年9月CT引导下肺穿刺活检的病例284例,分析穿刺并发症的发生与性别、年龄、病灶大小、深度、病灶周围有无肺气肿、穿刺次数、穿刺针粗细等的关系,并进行统计分析.结果:共发生气胸26例,出血(包括肺内出血和针道出血)48例.并发症的发生与病灶大小、深度、病灶周围有无肺气肿、穿刺次数、穿刺针粗细及年龄有关(P＜0.05).结论:CT引导下经皮肺穿刺活检常见并发症有气胸和出血.病灶大小、深度、病灶周围肺气肿、穿刺次数、穿刺针粗细以及年龄是肺穿刺活检并发症的相关因素.     

艾滋病并发症中CT引导下经皮肺穿刺活检术的应用

目的：探讨CT引导下经皮穿刺活检术在艾滋病肺部病变中的应用、诊断价值及其暴露防护。方法：回顾性分析16例经皮肺穿刺活检的相关资料,男10例,女6例,平均年龄28.7岁;其中单个病灶7例,多发块影或结节影5例,大片实变影4例,合并纵隔淋巴结肿大4例,合并胸水3例。结果：所有病例均穿刺成功,16例患者行18例次穿刺,12例病例获得诊断,其中肺结核6例,真菌感染3例,细菌感染3例,诊断符合率66.7%;不能明确诊断4例。术后并发症：病灶周围出血5例,少量气胸3例。无医护人员暴露感染。结论：CT引导下经皮肺穿刺活检较为安全,有利于患者早期诊断,操作应严格预防暴露感染。     

MDCT-Guided Transthoracic Needle Aspiration Biopsy of the Lung Using the Transscapular Approach

The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients.     

Image-directed percutaneous biopsies with a biopsy gun

Core tissue for histologic study is believed by many pathologists to be more diagnostic than material from needle aspiration. Recently, a biopsy "gun" has been introduced, which simplifies core biopsies. With this device, 182 biopsies of multiple anatomic sites were performed with ultrasonic, computed tomographic, and fluoroscopic guidance and 18-gauge needles. High-quality histopathologic specimens were obtained in 177 of the biopsies, and diagnostic target tissue was obtained in 167. Only three significant complications occurred: one bleeding complication that required transfusion and two cases of pneumothorax that necessitated placement of chest tubes. The biopsy gun eliminated the disjointed movements of conventional "skinny" needle biopsies, and none of the samples demonstrated significant "crush" artifact or obscuring blood, problems that are commonly associated with manual biopsy techniques. Patient discomfort was decreased with this system compared with that of manual biopsies, and the total procedure time was reduced. Because of these distinct advantages, the authors now use the biopsy gun exclusively for all percutaneous biopsies and recommend that other institutions consider the use of this biopsy method.