Interventional Radiology Procedures in Biopsy and Drainage (eBook)

Dr. Debra Gervais is Director of Pediatric Imaging and Associate Director of Abdominal Imaging and Intervention at Massachusetts General Hospital, Boston, Massachusetts, USA. Dr. Tarun Sabharwal is a Consultant Interventional Radiologist at Guy’s and St Thomas’ Hospital, London, UK.

Foreword 6
Preface from the Series Editors 8
Preface from the Editors 9
Contents 10
Contributors 12
General Principles of Biopsy and Drainage 14
Patient and Procedure Selection 14
Diagnostic 14
Therapeutic 14
Consent 15
Sedation 15
Benzodiazepines 15
Anesthetic Input for Conscious Sedation 15
Analgesia 16
Local 16
Systemic 16
Antibiotics 16
Hemostasis 16
Factors Influencing This Include 16
Procedures May Be Graded into Low, Moderate and Significant Bleeding Risk 17
Laboratory Values 17
Medication 17
Embolization 17
Complications and Management 18
Bleeding: Management 18
Infection: Management 18
Unintended Transgression of Organ: Management 18
Imaging Guidance, Access and Planning 19
Abscess/Cavity Drainage Tools and Techniques 20
Biopsy Tools and Techniques 21
Puncture Site Plugging 22
Conclusion 23
Key Questions to Address 23
Suggested Reading 23
Liver Biopsy 24
Clinical Features 24
Diagnostic Evaluation 24
Clinical 24
Laboratory 25
Imaging 25
Indications 25
Contraindications 25
Alternative Therapies 25
Anatomy 26
Normal Anatomy 26
Aberrant Anatomy 26
Equipment 26
Biopsy Needles 26
Medication 27
Procedure 27
Ultrasound-Guidance 27
CT Guidance 28
Planning an Access Route 29
Technique 30
Tissue Preparation 31
Immediate Post-procedure Care 32
Follow-up and Post-procedure Medications 32
Results 32
Complications 32
Suggested Reading 33
Chest Biopsy 34
Clinical Features 34
Diagnostic Evaluation 34
Clinical 34
Laboratory 34
Imaging 35
CXR 35
CT 35
PET 35
US 35
Lung Needle Biopsy Indications 35
Lung Needle Biopsy Contraindications 35
Absolute 35
Relative 36
Relevant Anatomy 36
Aberrant Anatomy 36
Patient Preparation 36
Equipment/Tools 37
Needle Types 37
Results 37
Pre-procedure Medication/Sedation/Analgesia 37
Procedure 38
Planning an Access Route 38
Image Guidance 38
Performing the Procedure 38
Technique 38
End Point 39
Immediate Post-procedure Care 40
Follow-up and Post-procedure Medication 40
Alternative Procedures 40
Complications: How to Avoid and Manage 40
Suggested Reading 43
Mediastinal Biopsy 44
Clinical Features 44
Diagnostic Evaluation 44
Laboratory 44
Imaging 44
Indications 45
Alternative Therapies (Listed in Order of Least to Most Invasive) 45
Contraindications (Relative) 45
Specific Complications 45
Anatomy 47
Normal Anatomy 47
Aberrant Anatomy 47
Equipment 48
Imaging Modality for Guidance 48
Biopsy Technique 49
Needles 49
Medication 49
Biopsy 50
Patient Position 50
Biopsy Approaches to the Mediastinum 50
Clinical Scenarios 55
Aftercare 55
Follow-up 55
Suggested Reading 56
Bone Biopsy 59
Introduction 59
Aim 59
Indications 59
Contraindications 60
Clinical presentation 60
Pre-procedure laboratory investigations 60
Equipment 60
Anesthesia 61
Image Guidance 61
Procedure 62
Post Biopsy Care 64
Complications 64
Results 64
Adrenal Biopsy 65
Clinical Features 65
Incidence 65
Differential Diagnosis for an Adrenal Mass 65
Diagnostic Evaluation 65
Imaging Features 65
Contraindications 66
Indications 66
Alternatives 66
Pre-procedure 67
Relevant Anatomy 67
Procedure Technique 67
Patient Positioning 67
Equipment and Biopsy 68
Results and Complications 69
Suggested Reading 70
Renal Biopsy 71
Clinical Features 71
Indications 71
Contraindications 72
General Principles 72
Patient Preparation 72
Access 72
Image Guidance 72
Sedation-Analgesia 73
Technique 73
General Complications and Management 74
Tools for Biopsy 74
Needle Types 74
Specimen Handling 74
FNA Versus Core 74
Alternatives 75
Post-Procedure Care and Follow Up 75
Key Points 75
Other Clinical Scenarios: Non-focal Renal Biopsies 75
Indications 75
Contraindications 76
Relevant Anatomy 76
General Principles 76
Patient Preparation 76
Access 76
Image Guidance 76
Sedation-Analgesia 76
Technique 76
General Complications and Management 76
Tools for Biopsy 77
Needle Types 77
Specimen Handling 77
Post-Procedure Care 77
Suggested Reading 77
Pancreatic Biopsy 78
Clinical Features 78
Therapy Options 78
Laboratory Evaluation 78
Imaging 79
Indications 79
Alternatives 79
Contraindications 80
Absolute Contraindications 80
Relative Contraindications 80
Organ Anatomy 80
Anesthesia and Sedation 80
Image Guidance 80
Access 81
Needles and Tissue Sampling 81
Complications 82
Aftercare and Follow-Up 82
Suggested Reading 83
Lymph Node Biopsy 84
Clinical Features 84
Diagnostic Evaluation 84
Discontinuation of Anticoagulants 84
Indications 85
Specific Complications 85
Anatomy-Specific Considerations 85
Equipment 88
Needles 88
Procedure 88
Techniques 88
Modality 89
FNA Versus Core 89
Suggested Reading 90
Splenic Biopsy 91
Clinical Features 91
Diagnostic Evaluation 91
Laboratory 91
Discontinuation of Anticoagulants 91
Indications 93
Specific Complications 93
Anatomy 93
Equipment 93
Needles 93
Medications 94
Procedure 94
Access 94
Modality 94
Aftercare 95
Followup 95
Suggested Reading 96
Thyroid Biopsy 97
Clinical Features 97
Indications 97
Contraindications 98
Relevant Anatomy 98
General Principles 98
Patient Preparation 98
Access 98
Image Guidance 98
Sedo-analgesia 99
Technique 99
General Complications and Management 100
Tools for Biopsy 100
Needle Types 100
Specimen Handling 100
FNA Versus Core 100
Alternatives 100
Suggested Reading 101
Prostate Biopsy 102
Clinical Features 102
Diagnostic Evaluation 102
Clinical 102
Laboratory 102
Imaging 103
Indications 103
Contraindications 103
Patient Preparation 103
Anatomy 103
Equipment 104
Pre-procedure Medications 104
Procedure 104
Immediate Post-Procedure Care 104
Immediate Post-Procure Care CT-guided Transgluteal Prostate Biopsy 106
Complications 106
Alternative Procedures/Future Directions 106
Suggested Reading 107
Drainage of Abdominal Fluid Collections 108
Diagnostic Evaluation 108
Patient Preparation 109
Relevant Anatomy 109
Procedure 111
Planning an Access Route 111
Performing the Procedure 111
Technique 111
Tips 112
Follow-Up and Post-Procedure 112
Abscess–Fistula Complex 114
Removal of Drain 114
Causes of Failure 115
How to Avoid 115
Suggested Reading 116
Drainage of Pelvic Fluid Collections 117
Clinical Features 117
Diagnostic Evaluation 117
Clinical 117
Laboratory 117
Imaging 118
Indications 118
Contraindications 118
Alternative Therapies 118
Patient Preparation 118
Relevant Anatomy 119
Normal 119
Aberrant/Altered 119
Equipment 119
Procedure 119
Technique 119
Planning an Access Route 120
Routes of Pelvic Drainage (Fig. 1a) 120
Transgluteal Approach 120
Anterior Approach 121
Transrectal or Transvaginal Access (Figs. 4 and 5) 122
Transperineal Approach 122
Endpoint 124
Results 125
Follow Up 125
Catheter Management 125
Suggested Reading 126
Drainage of Intrathoracic Fluid Collections 127
Clinical Features 127
Diagnostic Features 127
Imaging Appearance 127
Thoracentesis 128
Percutaneous Catheter Drainage 128
Indication for Chest Catheter Drainage 129
Indicators of Successful Drainage 130
Clinical Scenarios 130
Parapneumonic Effusions and Empyema 130
Pneumothorax 130
Lung Abscess 132
Mediastinal Abscess 132
Pleurodesis 132
Normal Anatomy 133
Aberrent/Altered Anatomy 133
Complications 134
Suggested Reading 134
Liver Cyst / Abscess Drainage 135
Clinical Features 135
Diagnostic Evaluation 135
Laboratory 135
Imaging 136
Indications/Contraindications 136
Simple Cyst 136
Hydatid Cyst 136
Liver Abscess 137
Patient Preparation 137
Equipment 137
Pre-proceure Medications 137
Procedure 137
Planning an Access Route 137
Procedure 137
Simple Cyst 138
Hydatid Cyst 139
Liver Abscess 139
Immediate Post-proceure Care 139
Follow-up and Postprocedure Medications 142
Simple cyst 142
Hydatid cyst 142
Liver abscess 142
Results 142
Simple Cyst 142
Hydatid Cyst 143
Liver Abscess 143
Alternative Therapies 143
Complications 143
Simple Cyst 143
Hydatid Cyst 143
Liver Abscess 144
Suggested Reading 144
Drainage of Pancreatic Abscess and Fluid Collections 145
Clinical-Pathologic Features 145
Imaging 145
Indications/Contraindications 146
Pseudocysts 146
Pancreatic Necrosis 146
Pancreatic Abscess 146
Image Guidance-Access Route 146
Technique 148
Pancreatic Abscess-Infected Necrosis 148
Pseudocysts 148
Aftercare 149
Endpoint 149
Alternative Therapies 149
Suggested Reading 150
Percutaneous Biliary Drainage and Stenting 151
Clinical Features 151
Diagnostic Evaluation 151
Clinical 151
Laboratory 151
Imaging 152
Indications 152
Alternative Therapies 152
Contraindications 152
Specific Complications 152
Patient Preparation 153
Anatomy 153
Normal Anatomy 153
Aberrant Anatomy 153
Equipment 153
Pre/Peri-procedure Medications 154
Procedure 154
Planning an Access Route 154
Performing the Procedure 156
Technique 156
Endpoint 157
Immediate Post-procedure Care 157
Follow-up and Post-procedure Medications 158
Results 158
Metallic Stenting 158
Complications 159
How to Avoid Complications 159
Medication 160
Follow-up 160
Suggested Reading 160
Percutaneous Cholecystostomy and Cholecystolithotomy 162
Percutaneous Cholecystostomy 162
Introduction 162
Diagnostic Evaluation 162
Clinical 162
Laboratory 163
Imaging 163
Indications 163
Contraindications 163
Absolute Contraindications 163
Relative Contraindications 164
Relevant Anatomy and Approach 164
Advantages of Transhepatic Approach 164
Equipment 164
Imaging Guidance 164
Medication 164
Hardware Requirements 165
Procedure 165
The Seldinger Technique 165
Trocar Technique 166
Post-procedure Care 167
Complications 167
Outcomes 168
Percutaneous Cholecystolithotomy 168
Important Considerations 168
Hardware Requirements 169
Procedure 169
Results 169
Complications 170
Suggested Reading 170
Percutaneous Nephrostomy and Antegrade Ureteric Stenting 171
Percutaneous Nephrostomy 171
Clinical Features 171
Diagnostic Evaluation 171
Indications 172
Relative Contraindications 172
Patient Preparation 172
Relevant Anatomy 173
Normal Anatomy 173
Aberrant Anatomy 173
Transplant Anatomy 174
Equipment 174
Procedure 175
Imaging Guidance 175
Positioning the Patient 175
Planning an Access Route 175
Performing the Procedure 175
Technique 175
End-point 176
Immediate Post-Procedure Care 176
Follow-Up and Post-Procedure Medications 176
Results 177
Alternative Therapies 177
Complications 177
How to Avoid 177
Antegrade Ureteric Stenting 178
Indications 178
Contraindications 178
Patient Preparation 178
Equipment 179
Pre-procedure Medication 179
Procedure 179
Imaging Guidance 179
Positioning the Patient 179
Technique 179
Choosing the Stent 180
End-Point 181
Immediate Post-Procedure Care 181
Follow-Up and Post-Procedure Medication 181
Results 181
Alternative Therapies 182
Complications 182
Early Complications 182
Late Complications 182
How to Avoid 182
Suggested Reading 183
Fluoroscopy-Guided Percutaneous Renal Access for Treatment of Stone Disease 184
Clinical Features 184
Diagnostic Evaluation 184
Laboratory 184
Imaging 184
Indications 185
Alternative Therapies 186
Contraindications 186
Specific Complications 186
Anatomy 186
Equipment 187
Access Technique 188
Suggested Reading 189
Percutaneous Gastrostomy and Gastrojejunostomy 190
Clinical Features 190
Diagnostic Evaluation 190
Clinical 190
Laboratory 190
Imaging 191
Indications 191
Contraindictaions 191
Absolute 191
Relative 191
Patient Preparation 191
Relevant Anatomy 192
Aberrant Anatomy 192
Equipment 193
Gastrostomy Tube 193
Gastropexy Kit (T Fasteners) 193
Stiff Guidewire 194
Medication 194
Procedure 195
Planning an Access Route 195
Performing the Procedure: Primary Button Gastrostomy 195
Gastropexy 195
Stomach Puncture 195
Measure Tract 196
Tube Insertion 196
Check Position 196
Performing the Procedure: Balloon- or Locking Pigtail-Retained Tubes 196
Performing the Procedure: “Endoscopic Type” Tubes 197
Immediate Post-Procedure Care 197
Gastrojejunostomy 197
Indications 197
Follow-Up 198
Alternative Therapies 198
Endoscopic Gastrostomy 198
Complications 198
Suggested Reading 199
Index 200