Transfemoral liver biopsy by forceps: a review of 104 consecutive procedures.

PURPOSE: Transvenous liver biopsy is performed on patients with contraindications to percutaneous biopsy. Transfemoral liver biopsy has not been widely reported, and we present our experience of 104 consecutive procedures. METHODS: During a 30-month period, 88 patients underwent 104 transfemoral liver biopsies. Under fluoroscopic guidance a 9 Fr curved introducer catheter is passed into the right hepatic vein via a standard femoral sheath. A 7 Fr biopsy forceps is then passed into the liver, opened and wedged. Prior to biopsy, the image intensifer is rotated so the relation of the capsular surface to the biopsy site is verified and capsular perforation avoided. RESULTS: Tissue samples obtained in 97 of 104 procedures (93%) were adequate for diagnosis in 83 (80%). Complications occurred in six procedures (6%) including two capsular perforations; the latter two were treated by coil embolization. CONCLUSION: We found transfemoral liver biopsy using forceps to be a safe, well-tolerated procedure with a high diagnostic yield and it is a technically easy alternative to the transjugular approach using large needles.

Wegener's granulomatosis: findings from computed tomography of the chest in 10 patients.

Radiographs and computed tomography (CT) scans of the chest were reviewed for 10 patients with pathologically proven Wegener's granulomatosis. The CT scans revealed multiple pulmonary nodules in seven patients and a single nodule in one. The nodules ranged in diameter from 2 mm to 7 cm, and most had irregular margins. All of the nodules larger than 2 cm in diameter showed evidence of cavitation in the CT scans. Additional CT findings included associated areas of consolidation (in two patients), pleural thickening (in two) and pleural effusion (in two). Chest radiographs were available for eight patients, and the CT scans contributed information additional to that available from the radiographs for seven of these. In one patient lung nodules were visible in the CT scans but could not be distinguished from surrounding areas of consolidation in the chest radiographs. CT revealed additional nodules in five of the six patients in whom multiple nodules were seen in chest radiographs and in one of these also revealed cavitation tht was not visible in plain radiographs. CT excluded the possibility of a nodule that was suspected from the chest radiographs in a patient who had been treated previously for Wegener's granulomatosis. The authors conclude that Wegener's granulomatosis is characterized in CT scans by multiple nodules with irregular margins and by cavitation in nodules larger than 2 cm in diameter. CT may also demonstrate nodules and cavitation not apparent in radiographs.

CT diagnosis of bronchial rupture.

Computed tomography in a patient with unsuspected rupture of the left mainstem bronchus revealed shift of the trachea to the right, with the remainder of the mediastinum being shifted to the left. The left mainstem bronchus was visualized only in its most proximal course. The combination of deviation of the trachea from the remainder of the mediastinum and abrupt cut off of the left mainstem bronchus suggested the diagnosis of ruptured bronchus.