Anmol Malhotra MD, Presenter: Nothing to Disclose

Siobhan Anna Whitley MBBS, Abstract Co-Author: Nothing to Disclose

Kate M. Rissik MBBS, Abstract Co-Author: Nothing to Disclose

Ali M. Naraghi MD, Abstract Co-Author: Nothing to Disclose

Otto Chan MD, Abstract Co-Author: Nothing to Disclose

Tim Fotheringham, Abstract Co-Author: Nothing to Disclose

Transcaval pancreatic biopsy using a coaxial technique has been previously demonstrated to obtain samples for cytological evaluation. However, we are not aware that mediastinal transcaval lymph node biopsy with a coaxial or trucut biopsy needle has been reported.Radiologists are occasionally asked to obtain tissue for histopathology from mediastinal lymph nodes. The histopathologist requires tissue from biopsy, rather than cells from fine needle aspirate, in order to be able to perform immunohistochemistry. Occasionally biopsy is thought not to be possible due to proximity to the superior vena cava (SVC) or because the SVC lies in the line of possible biopsy. Most radiologists will decline because they will not biopsy trans cava. Patients will have unnecessary surgery or mediastinoscopy with the associated increase in morbidity and mortality. Using techniques described we aim to demonstrate there are few patients with mediastinal adenopathy who cannot have tissue obtained by CT guided biopsy.

We describe five cases of CT guided transcaval mediastinal lymph node biopsy where an alternative radiological route was unavailable. In four cases trucut biopsies were performed and in two cases biopsies were obtained using a coxial technique. Approaches used were in order to minimize possible complications from long trans thoracic or posterior thoracic approaches.

In all six cases (100%) adequate tissue for histopathological diagnosis was obtained. The only complication was a mediastinal haematoma detected on CXR in one case (17%). All patients were spared invasive surgery or mediastinoscopy in order to obtain a diagnosis.

Trans cava lymph node biopsy is an appropriate means of obtaining tissue for pathological diagnosis when alternative radiological approaches are unacceptable. Using these techniques, there are few patients with mediastinal adenopathy who cannot have tissue obtained by CT guided biopsy.

Malhotra, A, Whitley, S, Rissik, K, Naraghi, A, Chan, O, Fotheringham, T, CT-guided Mediastinal Transcaval Lymph Node Biopsy.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4409504.html