Safety and efficacy of sonographic-guided random real-time core needle biopsy of the liver.

PURPOSE: To determine the safety and efficacy of real-time, sonographic-guided, random percutaneous needle biopsy of the liver in a tertiary medical center. METHOD: From an IRB-approved biopsy database, all patients who had random liver biopsy performed over a 24-month period were selected. In 350 patients, 539 random percutaneous needle biopsies of the liver were performed under real-time sonographic visualization. The following were recorded from the electronic medical record: patient demographics, indication for biopsy procedure; radiologist's name; needle type and gauge and number of passes; use and amount of i.v. sedation or anesthesia; adequacy of the specimen; and complications following the procedure. RESULT: Of 539 biopsies, 378 (70%) biopsy procedures were performed on liver transplant recipients. Of the biopsy procedures in nontransplant patients, 81/161 (50%) concurrently underwent biopsy of a focal liver mass. An 18-gauge automated core biopsy needle was used in 536/539 (99%). Median number of passes per biopsy procedure was 1 (mean, 1.7; range, 1-6). Sedation using midazolam and fentanyl was used in 483/539 (90%). There were only 8 inadequate specimens (1.5%, [2.3, upper 95% confidence limit, fully described in Statistical Analysis]). Complications were identified in 11/539 biopsy procedures (2.0%, [2.6, upper 95% confidence limit]): 5 with severe postprocedural pain, 3 with symptomatic hemorrhage, 2 with infection, and 1 with a rash. There were no sedation-related complications and no deaths related to the procedure. CONCLUSION: Real-time, sonographic-guided, random core-needle liver biopsy is a safe and highly effective procedure.

Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life.

A 31 year old woman presented with the worst headache of her life and was diagnosed with cerebral venous sinus thrombosis (CVST) by routine unenhanced computed tomography (CT) scan, subsequently confirmed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Awareness of this less common cause for acute neurological presentation in the Emergency setting is important; the imaging characteristics of CVST are reviewed.

Inflammatory myofibroblastic tumor of the lung: recurrence after steroid treatment.

We report a case of a patient with inflammatory myofibroblastic tumor of the lung, which recurred after steroid treatment. The diagnosis of the tumor was confirmed by a core needle lung biopsy and pathology. The patient was initiated on steroid therapy, which on complete response was slowly tapered and discontinued. Few months later, the patient presented with dyspnea again. Chest radiography and computed tomography scans depicted recurrence at the tumor resection site in the right lobe of lung and a new tumor in the left lower lobe. Restarting the steroid therapy, led to regression of the tumors at both sites. This is a rare case of inflammatory myofibroblastic tumor recurring poststeroid therapy and adds to the current clinical knowledge about this peculiar manifestation of this disease entity.