Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients.

PURPOSE: To assess the safety of fluoroscopically guided drill-assisted bone marrow aspirate and biopsy in severely thrombocytopenic patients. MATERIALS AND METHODS: The study was approved by the IRB with waiver of informed consent. Retrospective review of 111 bone marrow aspirate and biopsies (BMAB) performed in 94 patients who received a CT scan which included the pelvis and biopsy site within the 7 days following the BMAB. The 94 patients were subdivided based on their platelet count: severe thrombocytopenia (< 20 platelets × 109/L), thrombocytopenia (20-50 platelets × 109/L), and control (> 50 platelets × 109/L). The procedure report was reviewed for sedation time, aspirate volume, and aggregate size of core biopsy specimens. The electronic medical record was reviewed for specimen adequacy; pathologic diagnosis; body mass index; pre- and post-procedure labs including platelet count, hemoglobin (HGB), hematocrit (HCT), prothrombin time (PT), and international normalized ratio (INR) levels; post-procedural transfusion; and complications including mortality at 30 and 90 days. CT scans were independently reviewed by 2 fellowship-trained radiologists for the presence of post-procedural hemorrhage. RESULTS: There was no significant difference in CT-identified post-procedural hematoma, or change in the hemoglobin and hematocrit levels pre- and post-procedure between the three groups. There was no significant difference in complication rate or all-cause mortality. There was a significant difference in transfusion at 30 days with thrombocytopenic and severely thrombocytopenic patients more likely to receive transfusion within the 30 days post-procedure. CONCLUSION: Fluoroscopically guided BMAB can be safely performed in patients with severe thrombocytopenia.

Benign fibrous hamartoma of infancy: a case of MR imaging paralleling histologic findings.

Fibrous hamartoma of infancy is a rare fibrous tumor of the subcutaneous tissue in infants. While most case reports focus on the unique histologic appearance, which has traditionally been relied upon for diagnosis, there are few reports in the radiology literature of its appearance at MR imaging. In this report, the authors present the case of a 9-month-old male who presented with a soft tissue mass on the shoulder. The MRI findings in benign fibrous hamartoma of infancy parallel the three components of the lesion seen histologically, with an organized arrangement of fat interspersed among heterogeneous soft tissue bands composed of mesenchymal and fibrous tissue. When present, this characteristic appearance may allow the diagnosis to be suggested preoperatively.