CT-Guided Trans-osseous Biopsy: Experience in 24 Patients.

PURPOSE: The objective of this study is to assess the effectiveness of computed tomography-guided trans-osseous biopsies in deep-seated lesions and report encountered complications. MATERIALS AND METHODS: A retrospective cohort study was performed which included twenty-four patients with pathologic medical history and lesions non-accessible by common approaches. Exclusion criteria include patients who could be biopsied without trans-osseous access, as for example procedures aided with hydro- or pneumo-dissection. The population studied included 13 females (54.2%) and the overall average age was 64.5 (IIQ 43-69). The procedures were carried out through the following bones: sternum (n = 6), vertebral (n = 5), iliac (n = 5), scapula (n = 3), rib (n = 2), sacral (n = 2), and pubis (n = 1). RESULTS: The efficiency for these procedures was 87.5%, while 8.33% of them were non-diagnostic and 4.17% were inconclusive due to vital risk during the procedure. CONCLUSION: Computed tomography-guided trans-osseous biopsy resulted in a safe and effective technique for those lesions blocked by vital structures or apparently directly inaccessible.

[Ultrasound guided biopsy of lung tumors: evaluation of efficacy and complications]. / Biopsia de tumores pulmonares con guía ecográfica: evaluación de eficacia y complicaciones

Introduction: The diagnosis of lung cancer, as well as that of lung nodules, is increasing. Percutaneous biopsy has become a transcendental tool for its diagnosis. Traditionally, computed tomography is used for these procedures because of its ability to clearly demonstrate bone and aerated lung. However, in selected cases it can be performed with ultrasound. Methods: Retrospective study conducted between January 2020 and December 2021, during the SARS-CoV-2 pandemic. All patients had pleural-based lung lesions or pleural lesions, some with a known history of cancer. Results: Thirty-six procedures were performed, in 32 (88.9%) the sample obtained presented diagnostic yield and the most used additional test was Immunohistochemistry in 23 (63.9%). Complications were reported in 5 patients (13.9%): 2 with mild pneumothorax, 2 with hemothorax (1 mild and 1 moderate) and 1 patient reported pain. Conclusion: Ultrasound is a valid method to be used as a guide for biopsies of pleural and peripheral pulmonary lesions. The complications and diagnostic rate has been shown to be in line with the experience of other authors and international guidelines.

Introducción: El diagnóstico de cáncer pulmonar al igual que el de los nódulos pulmonares se encuentra en aumento. La biopsia percutánea se ha convertido en una herramienta trascendental para su diagnóstico. Tradicionalmente la tomografía computada es empleada para estos procedimientos por su capacidad para demostrar con claridad los huesos y el pulmón aireado. Sin embargo, en casos seleccionados puede efectuarse con ecografía. Métodos: Estudio retrospectivo realizado entre enero de 2020 y diciembre de 2021, durante la pandemia por SARS-CoV-2. Todos los pacientes tenían lesiones pulmonares de base pleural o lesiones pleurales, algunos con antecedentes conocidos de cáncer. Resultados: Se realizaron 36 procedimientos, en 32 (88,9%) la muestra obtenida presentó rédito diagnóstico y la prueba adicional más utilizada fue la Inmunohistoquímica en 23 (63,9%). Se reportaron complicaciones en 5 pacientes (13,9%): 2 con neumotórax leve, 2 con hemotórax (1 leve y 1 moderado) y 1 paciente refirió dolor. Conclusión: La ecografía es un método válido para ser usado como guía de biopsias de lesiones pleurales y pulmonares periféricas. La tasa de complicaciones y reedito diagnóstico ha demostrado estar en línea con la experiencia de otros autores y guías internacionales.

[Presurgical hypogastric lymph node marking under CT guidance, aided by hidrodissection] / Marcación prequirúrgica de ganglio hipogástrico con tomografía computada asistido por hidrodisección.

Introduction: Pre-surgical lymph node marking is an established medical procedure of vital importance in the treatment of cancer patients. Materials: A 60-year-old man with a history of prostatic adenocarcinoma in a plan for resection of hypogastric adenopathy. Image guided pre-surgical marking was indicated. Results: Preoperative marking was performed with local anesthesia under computed tomography with transosseous access and hydrodissection. Conclusion: We present a technique that has been little studied and rarely reported in the international literature for the surgical identification of deep pelvic adenopathy.

Introducción: La marcación pre quirúrgica de ganglios es un procedimiento médico establecido y de vital importancia en el tratamiento de pacientes oncológicos. Materiales: Hombre de 60 años con antecedentes de adenocarcinoma prostático en plan de resección de adenopatía hipogástrica. Se indicó marcación prequirúrgica mediante guía imagenológica. Resultados: Se realizó marcación prequirúrgica con anestesia local bajo tomografía computada con acceso transóseo e hidrodisección. Conclusiones: presentamos una técnica poco estudiada y escasamente reportada en la bibliografía internacional para la identificación quirúrgica de una adenopatía pélvica profunda.

MDCT findings after hepatic chemoembolization with DC-beads: what the radiologist needs to know.

Transcatheter arterial chemoembolization with drug-eluting beads (TACE-DC-beads) is a new local treatment for primary or metastatic liver tumors. Despite technical efforts to achieve highly selective embolization of the tumor-supplying vessels, small, or large insults to the non-tumorous parenchyma are inevitably induced by the embolic materials or procedure itself. Parenchymal changes following TACE-DC-beads include bile duct injuries (bile duct dilatation, periportal edema, and bilomas), obliteration of intrahepatic portal vein branches, hypodense ill-defined areas, and perilesional parenchymal enhancement. The radiologist must be familiar with the changes induced by this treatment in order to distinguish therapeutic effect and collateral findings from complications and residual or recurrent tumor.