Cause Of Jaundice Research Articles

Jaundice in pregnancy and its causes: A case report

Jaundice in pregnancy is an uncommon condition, affecting less than 5% of pregnant women globally and it carries a high risk of maternal and perinatal mortality. Although there are various causes of jaundice in pregnancy, viral hepatitis infection is the most common cause in India. This is a case of a 28-year old woman, in her third trimester who presented with severe nausea, vomiting and edema in her extremities. Laboratory tests revealed severe oligohydramnios with altered blood and electrolyte profile. A clinical diagnosis of jaundice in pregnancy was made and the patient underwent an emergency caesarean section due to the high-risk nature of her pregnancy. The causes of jaundice in pregnancy include acute fatty liver of pregnancy (AFLP), hyperemesis gravidarum, hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome, viral hepatitis and intrahepatic cholestasis of pregnancy. Due to the acute onset of her condition and based on the principle of elimination, acute fatty liver of pregnancy was suspected as the cause of jaundice in this patient. After delivery, the patient received several blood transfusions and was placed on conservative treatment for a week. Both, mother and child, recovered well and were discharged without any complications.

Prolonged jaundice after previous SARS-CoV-2 infection: a clinical case report

The hepatobiliary system can be affected by a new coronavirus infection (COVID-19), in addition to the respiratory organs. Vanishing bile duct syndrome (VBDS) is a rare cause of jaundice that usually develops as a result of drug-induced liver injury or possibly due to the combined effect of several etiological factors.Clinical case. A 77-year-old patient was hospitalized due to jaundice, skin itching and dark urine. Symptoms first appeared 1 month after COVID-19 treated with ceftriaxone and were accompanied by an increase in biochemical markers of cholestasis. Both extra- and intrahepatic bile ducts injuries were excluded. Liver histology revealed VBDS. Treatment with ursodeoxycholic acid for 11 months led to complete resolution of jaundice, regression of pruritus and a decrease in biochemical markers of cholestasis.Discussion. This clinical case is of interest in connection with the development of VBDS in a patient after coronavirus pneumonia treated with ceftriaxone. VBDS is rarely included in the differential diagnosis of cholestatic syndrome, which is partly due to the lack of awareness of physicians about the complications that develop after COVID-19 and drug therapy.

Foetomaternal Outcomes of Jaundice in Pregnancy at a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Jaundice complicates 3 to 5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. It is responsible for approximately 10% of maternal deaths. Aim: To study the prevalence of jaundice in pregnancy, evaluate the important causes of jaundice encountered in pregnancy, and study the effects of jaundice during pregnancy on both maternal and foetal outcomes. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India, from March 1, 2021, to August 31, 2022. A total of 90 cases of pregnancy with jaundice were included in the present study. Detailed history, clinical examination, laboratory investigations, diagnosis, management, and outcomes in terms of maternal and perinatal morbidity and mortality were recorded. Data were analysed using the Chi-square test, with a statistical significance level set at p<0.05. Results: The total number of deliveries was 20,087, out of which 90 (0.45%) patients had jaundice. The prevalence of jaundice in pregnancy was 4.5 per 1000. The aetiologies of jaundice were viral hepatitis in 23 cases (25.55%), followed by intrahepatic cholestasis in 22 cases (24.44%), preeclampsia in 13 cases (13.33%), and Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome in 6 cases (6.66%). There were 12 (13.33%) maternal deaths and 17 (18.88%) neonatal deaths. Two (2.22%) babies were stillborn, and 1 (1.11%) case experienced Intrauterine Foetal Death (IUFD). The maternal death rate due to HELLP syndrome was 66.66% (4 deaths out of 6 cases). Conclusion: Viral hepatitis is the most common cause of jaundice in pregnancy. Although viral hepatitis due to the faecooral route is more common in India, the present study showed that Hepatitis B is more common during pregnancy

Treatment principles of Ayurveda to manage Kamala (Jaundice): A case study

Abstract Jaundice is a condition, in which hyperbilirubinemia is found along with yellowish discoloration of the sclera, skin, mucous membrane, and interstitial fluid. The causes of jaundice are hemolytic diseases, hepatocellular dysfunction, and obstructive disorders of the hepatobiliary system. Clinical manifestations of jaundice arise when the blood bilirubin level exceeds 2.5 mg/dL. Jaundice can be put under the heading of Kamala described in Ayurvedic texts. A 12-year-old girl was visited in the outpatient department of the Kayachikitsa department at Ch. Brahm Prakash Ayurved Charak Sansthan with the chief complaints of low appetite, gaseous abdomen, yellowish discoloration of sclera, weakness, and vertigo for 1 week. The patient was investigated in the hospital and was diagnosed Jaundice with investigation. The patient was effectively managed by the combination of Phaltrikadi Kwath 20 mL empty stomach in the morning, combined powder of Katuki Churna 1 g and Bhumi Amalaki Churna 1 g after food with lukewarm water twice a day, and 15 mL of Abhyarishta at night with normal water was given. The outcome was assessed based on symptoms, and lab investigations showed profound results. Therefore, it can be said that these medications are quite successful in treating jaundice.

Screening of G6PD Deficiency in Newborns at a Tertiary Care Teaching Hospital in Assam, North East India: A Cross-sectional Study

Introduction: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the most frequently encountered enzymopathy in humans. It is closely linked to neonatal jaundice, chronic non-spherocytic haemolytic anaemia, and acute haemolytic anaemia. G6PD deficiency is a common cause of jaundice among neonates. Aim: To screen for G6PD deficiency among newborns at a tertiary care teaching centre in Assam. Materials and Methods: This hospital-based cross-sectional study was conducted in the postnatal ward of the Department of Paediatrics at Medical College & Hospital, Dibrugarh, Assam, India, from June 2021 to May 2022. A randomly selected sample of 630 term neonates aged between 24 hours and 7 days of life was included in the study. A 2ml blood sample was collected in an Ethylenediamine Tetra-acetic Acid (EDTA) vial from each neonate, and G6PD enzyme activity was estimated using the Kinetic Method with a commercially available G-six kit. Newborns with G6PD enzyme activity values less than 6.4 U/g Haemoglobin (Hb) were considered G6PD deficient. Data, including age, sex, religion, Total Serum Bilirubin (TSB/NBIL), G6PD activity, and Hb of the neonates, were entered into pre-designed forms. The data were analysed using the Chi-square test. Results: Among the 630 screened neonates, 48 were found to be G6PD deficient, of which the majority were males (34 males, 14 females), resulting in a male-to-female ratio of 2.4:1. The occurrence of G6PD deficiency was 7.62%. The mean G6PD enzyme activity in deficient neonates was 4.53±1.17 U/g Hb. Conclusion: This study identified a significant occurrence of G6PD deficiency in newborns, including females. The mean G6PD enzyme activity in deficient neonates was significantly lower than in normal cases.

Obstructive Jaundice

Jaundice is a medical condition in which the skin or sclera of the eyes becomes yellow, and elevation of bilirubin production or obstruction of bile excretion can cause jaundice while disrupting the balance between bilirubin production and bile excretion. Jaundice is a very visual clinical sign that both patients and physicians can easily recognize. It warrants further investigation regarding the cause of jaundice because jaundice is always a pathological sign regardless of its seriousness. Clinical manifestations of obstructive jaundice can be understood in terms of bile formation and secretion, and the anatomy of the biliary tree. Obstruction of a critical part of the biliary tree such as the common bile duct can cause jaundice, and investigating the etiology of jaundice is the first step of managing this condition. Choledocholithiasis, pancreatic ductal adenocarcinoma, cholangiocarcinoma, and biliary atresia are some of the common medical conditions that cause obstructive jaundice. Whenever jaundice is observed by a physician, early diagnosis and prompt treatment should be performed as early as possible for better outcomes.

Fifteen-minute consultation: Baby with jaundice in the first 2 weeks of life

There are multiple causes of jaundice in the first 2 weeks of life. The aim of this article is to help explain what these causes are and why they occur....

Clinical and Physiological studies of jaundice in the newborn infants and novel design and diagnostic method for neonatal hyperbilirubinemia determination

Today, jaundice is one of the most common problems in newborns. Loss of Red Blood Cells (RBC) is the cause of jaundice. RBC rupture is known as hemolysis, and if hemolysis occurs faster than the liver excretes, bilirubin levels in the body rise and leading to jaundice. Bilirubin is directly soluble in water and is transported to the liver and excreted in stages, most of which is excreted in the feces and a small amount is excreted in the urine. Measuring bilirubin levels in infants is one of the essential tests after birth. In measuring the amount of jaundice in infants, complex components such as the formation of body organs, compounds on the skin of the infant, and other parameters are involved. Making a device to measure the amount of jaundice. The difference in the methods of measuring and treating jaundice in infants depends on the condition of the infant with jaundice. Non-invasive methods are used in infants with low bilirubin levels, but in acute and critical cases, invasive and direct methods are used. Jaundice tests are performed on both infected and healthy infants and are not limited to sick infants.

Prevalence of Glucose-6-phosphate Dehydrogenase (G6PD) Deficiency in Jiroft City in Southern Iran

Background and Aims: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a global problem and the most common cause of jaundice in neonates. Hence, this study was conducted to investigate the prevalence of G6PD deficiency in Jiroft city in southern Kerman.
 Materials and Methods: This descriptive cross-sectional study was carried out from 2016 to 2019. Blood samples were taken from all patients referred to Imam Hospital in Jiroft city in southern Iran. The G6PD enzyme activity was evaluated by a fluorescent spot test.
 Results and Conclusions: In the present study, a total of 7791 newborns were included. Abnormal activity of G6PD was seen in 779 (10%) subjects. Out of 779 patients, 728 (9.4%) were found to be G6PD deficient, and 49 (0.6%) exhibited partial deficiency. A relatively high percentage of G6PD deficiency was seen in newborns of Jirof city. We strongly recommend screening for G6PD enzyme activity in all newborns in this city.

Patient with Jaundice, Dyspnea and Hyperferritinemia after COVID-19

The aim: to highlight the importance of considering hemophagocytic lymphohistiocytosis in patients with jaundice of unclear origin and systemic inflammatory manifestations after coronavirus infection.Key points. A 64-y.o. patient was admitted to the hospital with jaundice, pruritus, fatigue, weight loss. The complaints occurred 2 weeks after discharge from the hospital for treatment of patients with coronavirus infection. Laboratory tests revealed signs of hepatic insufficiency, markers of cholestasis and inflammation persisted in time. Upon instrumental examination no signs of hepatosplenomegaly, biliary tree changes, intra- and extrahepatic obstruction were found. S. aureus was identified in blood cultures, CT scan of the facial skull bones showcased the focus of infection in the area of the roots of teeth 2.4 and 2.5. Therefore, antibiotics were prescribed. Subsequently, the patient's condition was complicated by the development of two episodes of acute respiratory distress syndrome, which occurred during the withdrawal of glucocorticosteroid therapy. Liver biopsy was performed, morphological study revealed signs of “vanishing bile duct” syndrome, excessive activation of macrophages and hemosiderosis of sinusoidal cells. Identified lesions can be found in hemophagocytic lymphohistiocytosis (HLH), a life-threatening complication of coronavirus infection. Glucocorticosteroids therapy, transfusions of human immunoglobulin, albumin, and parenteral nutrition have led to patient's condition improvement.Conclusion. COVID-19 provokes the development of secondary HLH 10 times more often than other respiratory viral infections. The possibility of hemophagocytic syndrome development should be considered, including cases of overlap syndrome with sepsis, in patients with unresolved jaundice, hyperferritinemia after coronavirus infection. Routinely used scales and criteria for diagnosis of HLH (H-score, HLH 2004) in such cases lacks sensitivity, therefore, careful analysis of clinical picture and exclusion of other causes of jaundice are required.

A hepatitis B virus flare that led to hepatic decompensation and liver transplantation in a pregnant woman with chronic hepatitis B: a rare case report and literature review

Background: Acute viral hepatitis is the most common cause of jaundice during pregnancy. Distinct immunological changes during pregnancy and the postpartum period are possible crucial factors associated with flares of chronic hepatitis B. Case: We present the case of a healthy pregnant hepatitis B virus (HBV) carrier at 38 weeks of gestation. She underwent an emergent cesarean section due to acute hepatitis B flare, and ultimately underwent liver transplantation due to a decompensating liver based on an estimated Model for End-Stage Liver Disease score. Conclusions: For pregnant HBsAg positive women, close monitoring with serum HBV-DNA and spartate transaminase (AST)/alanine transaminase (ALT) levels every 3 months is highly recommended. According to the latest guidelines, prenatal antiviral therapy, postpartum HBV vaccination, and hepatitis B immunoglobulin should be administered to prevent mother-to-child transmission.

CHOLESTATIC JAUNDICE AS A CLINICAL PRESENTATION OF HODGKIN’S LYMPHOMA IN A 20-YEAR-OLD SAUDI MALE PATIENT, A CASE REPORT

Background: Hodgkin lymphoma (HL) represents approximately 10% of lymphomas and is curable in most, but not all, patients. It has a bimodal incidence, although it most commonly presents in young adults. Presentation with mediastinal, cervical, and supraclavicular involvement is particularly common for the nodular sclerosing subtype. Patients may also present with B symptoms, although that is more commonly seen in elderly patients with more advanced disease. Pruritus may also be a presenting symptom. The diagnosis is established with a lymph node biopsy specimen showing Reed-Sternberg cells, malignant cells that originate from germinal center B cells and are seen in an inammatory inltrate. Case Report: We report a case of a 20 years old Saudi male presented to our emergency department with jaundice without clinical lymphadenopathy, accompanied with laboratory investigations that is showing intrahepatic cholestasis. The patient was admitted initially to evaluate the causes of jaundice that he has mainly by investigating hepatic and post-hepatic diseases. Months later, he has developed palpable lymphadenopathy. Surgical excisional biopsy result concluded that the patient is having Hodgkin's lymphoma. Conclusion:Although it is thought to be an uncommon cause of intrahepatic cholestatic, lymphomas should be considered in evaluating a patient who came with similar presentation.

Prevalence of Sepsis among Iranian Newborns with Jaundice: A Meta-Analysis Based on Cross-Sectional Studies

Background: Jaundice is a common life-threatening disease in the neonates. Several factors play a role in the etiology of jaundice. Sepsis is a possible cause of jaundice after blood group incompatibility. Bacterial infection and jaundice may be associated with higher morbidity. To date there exists no systematic review and meta-analysis that evaluated the Prevalence of sepsis in Iranian newborns with jaundice. Thus, in this study we evaluated the prevalence of sepsis among Iranian newborns with jaundice. Methods: A comprehensive literature search in Persian and English was performed on PubMed, Web of Sciences, Scopus, Google Scholar, Magiran and Scientific Information Database (SID) till July 2021. Data analysis was done by CMA version 2.0 software. Results: A total of eight publications with 4434 newborns with jaundice out of approximately 105 retrieved articles were selected. 211 neonates had sepsis. Pooled data revealed that the overall prevalence of sepsis among Iranian newborns with jaundice was 4.7% (95% CI 0.041-0.202, P ≤ 0.001) and there was no publication bias. Conclusion: This study showed that the prevalence of sepsis among Iranian newborns with jaundice was 4.7% and sepsis was a plausible reason of unexplained Hyperbilirubinemia among newborns with jaundice. To better understand the relationship between jaundice and sepsis, more studies with large sample sizes are needed.

Hepatitis B in pregnancy – Review of literature and guideline proposal

Vertical mother-to-fetus transmission of hepatitis B virus (HBV) is a concern of public health global policies. The transmission rate can be substantially influenced by the good function of the maternal screening programs and by the vaccination of newborns as well. Also, the appropriate treatment of pregnant women and the administration of anti-HBV immunoglobulin immediately after birth come up with the decrease of HBV transmission rate. Acute viral hepatitis during pregnancy constitutes the main cause of jaundice recognized in pregnant women. It has generally a mild course during pregnancy, without significantly influencing the health state of the mother. In the context of immunological adaptation in pregnancy, the condition of the pregnant woman with chronic HBV infection without notable hepatic dysfunction generally has a good evolution. However, there are some possible clinical consequences like hepatic flares and progression of liver disease. The paper presents a review of literature and guideline proposals to prevent vertical transmission of hepatitis B virus and to provide the best possible care for pregnant women with hepatitis B infection.

Epidemiology and Management of Unconjugated Hyperbilirubinemia

Unconjugated hyperbilirubinemia is characterised by increased serum or plasma bilirubin (unconjugated) levels that exceed the laboratory's reference range. Unconjugated hyperbilirubinemia, is the most common cause of jaundice in newborns. Unconjugated hyperbilirubinemia is caused by bilirubin metabolism dysregulation, which includes increased synthesis, reduced hepatic absorption, and decreased bilirubin conjugation. Gilbert syndrome (type 1 and 2), Crigler-Najjar syndromes (type 1 and 2), and hereditary illnesses producing hemolytic anaemia are all examples of inherited conditions that can cause unconjugated hyperbilirubinemia. Crigler-Najjar syndrome is a sporadic condition, Gilbert syndrome is more common yet less dangerous symptom. Using phototherapy and plasmapheresis, the major goal of treatment is to lower the amount of unconjugated bilirubin. Intensive phototherapy is the basis of management of Crigler-Najjar syndrome type 1. Combined with plasmapheresis and in some cases liver transplantation may be required.

Feto-Maternal Outcome in Patients with Jaundice During Pregnancy

Objective: To find out causes and feto-maternal outcome among patients presented with jaundice during pregnancy. Material and methods: This study was conducted at Isra university Hospital over period of one year from January 2018 to December 2019 in OBS and gynecology department. A total of 50 females having singleton pregnancy and having jaundice were included in the study after taking verbal informed consent. All the patients underwent normal vaginal deliveries and cesarean section as per indications and Hospital protocol. All the information regarding demographic characteristics including maternal and fetal outcome in terms of complications and mortality was collected via self-made study proforma and data was analyzed by SPSS version 20. Results: Total 50 patients were included in this study and 50% belonged to the age group of more than 30 years. 50% were un-booked, multigravida were 80% and 60% women poor socioeconomically. Most of the females had jaundice occurrence during the third trimester. Most patients 40% had jaundice due to viral hepatitis. Major maternal complications were the coagulation failure and renal impairment among 40% and 20% of the cases respectively, followed by septicemia, hepatic coma, hepatic coma, ICU admission, Abruptio placenta, PPH and maternal mortality were found with the percentage of 12.0%, 10.0%, 20.0%, 28.0%, 30.0% and 4.0% respectively. As per neonatal complications, fetal distress was 20.0%, still births were 10.0% and IUD were 10.0%. Conclusion: As per study conclusion the most common cause of jaundice was viral hepatitis. Coagulation failure, renal impairment, abruptio placenta and PPH were observed to be the commonest maternal complications, while fetal distress, IUD and still birth were the frequent fetal complication among patients presenting with jaundice during pregnancy. Keywords: Jaundice, feto-maternal outcome, viral hepatitis

Neonatal Jaundice Detection Using a Computer Vision System

Jaundice or Hyperbilirubinemia is a very common condition that affects newborns in their first few weeks of life. The main cause of jaundice is the high level of the bilirubin substance in the blood. As bilirubin is toxic to brain cells, acute bilirubin encephalopathy can occur in cases of extreme jaundice. This condition can result in brain trauma and lead to kernicterus, which causes repetitive and uncontrolled movements, a permanent upward look, and hearing loss. Thus, a timely diagnosis and treatment can help in preventing long-term damage. In this paper, a developed system based on a digital camera was proposed to diagnose and treat jaundice in newborns. The system detects jaundice and determines if the neonate needs treatment based on the analysis obtained from the real-time captured images. The treatment was achieved by using an Arduino Uno microcontroller to drive phototherapy lighting, which has proven to be an efficient treatment method for jaundice. In addition, the proposed system has the ability to send the diagnostic results to the mobile phone of the care provider. The obtained results from 20 infants inside the intensive care unit showed that the proposed system was accurate in terms of detecting jaundice, easy to implement, and affordable.

English

BACKGROUND Jaundice in pregnancy contributes to a significant proportion of maternal and perinatal morbidity and mortality in our country. Overall incidence in India is 1 - 4 per 1000 deliveries. There are increased risks of preterm labour, low birth weight babies, meconium-stained liquor, intrauterine fetal death and postpartum haemorrhage. The purpose of this study was to assess the fetomaternal outcome in pregnancy with jaundice in a tertiary level hospital. METHODS This was a two-year retrospective observational study conducted by reviewing the records of jaundice in pregnancy from April 2018 to March 2020. RESULTS Viral hepatitis comes out as the most common cause accounting for 70.37 % of the cases, whereas intrahepatic cholestasis with an incidence of 20. 37 % comes out as the second aetiology. Post-partum haemorrhage is depicted as the major maternal complication whereas prematurity and birth asphyxia come out as the major perinatal complications. CONCLUSIONS The present study projects viral hepatitis (Hepatitis A and E) as the major cause of jaundice in pregnancy. Although low maternal mortality has been recorded in the present study, a high perinatal mortality due to low birth weight and birth asphyxia remains to be a matter of major concern. KEY WORDS Jaundice in Pregnancy, Viral Hepatitis, Postpartum Haemorrhage, Prematurity, Birth Asphyxia

Diagnostic Efficacy of MRCP and Ultrasound on Obstructive Jaundice-A Prospective Study

Background: Obstructive jaundice is a common pathological problem that occurs when there is an obstruction to the passage of conjugated bilirubin from liver cells to intestine. Bile, a digestive fluid secreted and produce by the liver. Most common cause of obstructive jaundice is due to gallstones. Objective: The aim of our study was to evaluate the diagnostic Efficacy of MRCP and Ultrasound on obstructive jaundice. Study design: A cross-sectional prospective study was performed. Material & Method: A cross-sectional prospective study was performed in 50 patients who came with the provisional diagnosis of obstructive jaundice were referred to ultrasound for primitive diagnosis and were then shifted to MRCP for a detailed diagnosis. The data was collected from the outpatient department facility of Pakistan Kidney and Liver Institute Hospital, Lahore. After informed consent, data was collected from MRI GE 1.5 Tesla, Ultrasound Canon Xanio. Results: The results revealed that there are 50 patients of obstructive jaundice. 20 were females’ patients and 30 were males’ patients, with age raging from 20-40 years. There were 17 patients out of 50 in our study which ultrasound showed negative results that were positive on MRCP there were 28 patients that were positive on both ultrasound and MRCP. There were 3 patients that were positive on ultrasound but negative on MRCP and 2 patients that were negative on both modalities Conclusion: Our study concluded that higher ratio of males then females in our sample size, RHC was positive in all the patients with dominant cause of jaundice was stone with in biliary channel. We found that MRCP has better efficiency comparative to ultrasound to detect jaundice and its etiology i.e., 90% true positive. Keywords: Magnetic resonance cholangiopancreatography, Ultrasonography, Obstructive jaundice DOI: 10.7176/JHMN/91-03 Publication date: July 31 st 2021

Role of PET/computed tomography and biopsy guidance in characterization of malignant biliary obstruction

Objective This prospective study was conducted to evaluate the diagnostic effect of PET/computed tomography (PET/CT) in patients with malignant biliary obstruction and if the metabolic information provided by PET/CT scan adds an incremental benefit while performing image-guided biopsies. Background Malignant biliary tract obstruction is a frequent cause of jaundice. PET/CT is used to evaluate such patients, and information delivered by PET images is used to guide biopsy procedure. Patients and methods This study was carried out from March 2016 to March 2018 on 52 patients diagnosed/suspected to have MTBO. They all were investigated by PET/CT. Results were compared with the results of contrast-enhanced CT in ∼42 cases and with magnetic resonance cholangiopancreatography (MRCP) in ∼15 cases. A group of patients had undergone PET/CT-guided biopsy (15 patients). Results This study revealed that sensitivity, specificity, positive predictive value, and negative predictive value for PET/CT were 92, 75, 96, and 60%, respectively, whereas for CT and for MRCP were 68, 60, 85, and 20% and 60, 50, 85, and 20%, respectively. PET/CT has sensitivity of 90% for detection of lymph nodal metastases compared with 37% for CT and 20% for MRCP. PET/CT is more sensitive than CT and MRCP for distant metastases detection. Conclusion PET/CT is more sensitive and specific than CT and MRCP in primary detection and staging of tumors causing malignant biliary tract obstruction. PET/CT-guided biopsy increases the chance of obtaining a definitive diagnostic result.