Combined sonographic and fluoroscopic guidance during transjugular hepatic biopsies performed in children: a retrospective study of 74 biopsies.

OBJECTIVE: Our aim was to evaluate the safety, effectiveness, and clinical impact of transjugular biopsies of the liver performed in children. MATERIALS AND METHODS: We retrospectively reviewed 74 transjugular hepatic biopsies performed in 64 pediatric patients. The selection criteria for transjugular approach in these children included mainly coagulopathy, thrombocytopenia, or ascites. The last 37 biopsies in our series were performed with combined sonographic and fluoroscopic guidance, which improved visualization of the biopsy tract. RESULTS: Adequate samples for histopathologic analysis were obtained in all except one case (98.6%). In most patients with fulminant hepatic failure, biopsy results allowed patients to be promptly listed for orthotopic liver transplantation; in patients with less severe hepatic failure, biopsy results helped guide medical management. In patients with liver transplants, the biopsy provided information on acute graft rejection; in patients who had undergone bone marrow transplantation, the biopsy helped to determine the status of graft-versus-host disease. One death occurred immediately after the procedure but at autopsy was deemed not to have been caused by the biopsy itself. Overall, procedural complications occurred in 8.1% of patients. Complications included neck hematomas, small subcapsular hematomas, subclavian artery puncture, and extravasation of contrast material into the retroperitoneum. CONCLUSION: Transjugular hepatic biopsy is a relatively safe procedure that has considerable impact on patient treatment. The addition of sonographic guidance during the biopsy improves visualization, increases operator confidence, and allows the performance of biopsies in smaller patients and in children with reduced liver transplants.

Gunshot wound to the thorax with bullet embolization to the external carotid artery.

Gunshot wounds are associated with major morbidity and mortality rates. If the patient survives the initial insult, all gunshot wounds require an assessment of the organs at risk and localization of the projectile. This case of a gunshot wound to the thorax with bullet embolization from the left ventricle to the right external carotid artery provides an overview of the imaging in this clinical scenario. Typically, right cardiac perforation results in embolization into the pulmonary vasculature, whereas left cardiac perforation results in embolization into the extremities.