Percutaneous transpulmonary CT-guided liver biopsy: a safe and technically easy approach for lesions located near the diaphragm.

Abstract

. lesions near the diaphragm are taibred to avoid pleural puncture and its concomitant risk of pneurnothorax. These approaches include an angled approach using either real-time sonographic guidance, CF guidance with gantry tilt, or CF guidance with triangulation [I, 2]. Of the techniques with CF guidance, triangulation or gantry tilt can be frustrating and time-consuming. The longer needle path through the liver inherent in these approaches increases the difficulty of the procedure and may increase the risk of complications, specifically hemoiThage. Small differences in respiration may make accurate needle positioning difficult, necessitating more punctures. Because of technical difficulties associated with these approaches, we began performing transpulmonary CF-guided liver biopsies when, because oflesion location, other approaches were deemed technically difficult or unsafe. Interventional mdiologists have anecdotal experience with transpleural and iranspulmonary approaches to liver lesions. However, to our knowledge, no reports of this technique exist in the literature. We therefore undertook this study to review our experience using the tninspWmonary approach.