Diagnostic accuracy and associated complications of percutaneous computed tomography guided core needle biopsy of pulmonary lesions using coaxial technique.

This study was conducted to determine the diagnostic accuracy of CT-guided core needle biopsy (CNB) using coaxial technique of pulmonary lesions, its complications and factors affecting them. A total of 122 patients with suspected lung malignancy underwent CT-guided CNB. Final diagnosis was confirmed by histopathology. There were 84 (89.4%) true positive while 26 (92.9%) true negative cases. Diagnostic accuracy, sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were 97.67%, 72.22%, 89.36%, 92.86% and 90.16% respectively. Pneumothorax was the only complication observed in 10 (8.2%) patients. The odds of pneumothorax was found to be 10.72 times higher among patients with 2.5cm of size of lesions (AOR 10.72, 95% CI 1.49-76.77) while 86% lower among patients having prone position (AOR 0.14, 95% CI 0.021-0.96). Results indicate that percutaneous CT guided biopsy of pulmonary lesions using coaxial technique is a safe procedure with a high diagnostic accuracy and lesser risk of major complications.

Appropriateness and clinical outcome of chest computed tomography without intravenous contrast: A study conducted in Pakistan.

BACKGROUND: Chest computed tomography (CT), including high-resolution CT (HRCT), has become an integral part of modern healthcare. It enables the physician to arrive at a diagnosis using a noninvasive approach. Our practice has shown that various chest CT scans without intravenous (IV) contrast, including HRCT, have no proper clinical indication. For the same reason, we have assessed the appropriateness of chest CT without IV contrast based on the evidence-based American College of Radiology (ACR) appropriateness criteria. METHODS: Chest CT scans without IV contrast were reviewed to evaluate if the examination was based upon the evidence-based ACR appropriateness criteria. All clinical indications, positive physical examination findings, laboratory test findings, and radiological records submitted at the time of chest CT were reviewed. RESULTS: Of 1205 CT scans, 538 (44.6%) were considered "inappropriate," 367 (30.4%) were considered "appropriate," and 300 (24.8%) were considered "may be appropriate." CT scans were performed on 241 (20.0%) patients with no clinical history, whereas 148 (12.3%) examinations in patients aged < 40 years were performed with no positive physical finding. Positive results that affected the management were 4.43 times more likely to be considered appropriate than inappropriate (adjusted odds ratio, 4.43; 95% confidence interval, 1.81-10.87). CONCLUSIONS: This study showed a high percentage of chest CT scans without IV contrast examinations not meeting the ACR appropriateness criteria. Chest CT is a valuable tool for evaluation of chest diseases only in the presence of adequate detailed history and physical examination.

Outcome of radiologically placed tunneled haemodialysis catheters.

OBJECTIVE: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. METHODOLOGY: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. RESULTS: Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed. CONCLUSION: Radiological guided tunneled haemodialysis catheter placements are a safe and reasonable means of providing temporary vascular access for haemodialysis patients.