CT-Guided Biopsy in a difficult Localisation in the Liver Hilum

Biopsy in the liver hilum to a suspected lesion with a difficult and long pathway without passing through the portal vein or puncturing the gallbladder. Biopsy was performed with 16G co-axial system with a 18G biopsy needle. Three cylinders were taken from the suspected tissue. The pathology shows a carcinoma with little differential, expressing CDX2 which means it is probably of pancreatic-biliary origin.

 
 
Case_Fribourg_2020_Overview
 
1 + 2: Planning scans of the biopsy showing the only possible pathway to the suspected lesion without passing through the portal vein or puncturing the gallbladder
3: Validation of the position of the biopsy needle
4: Verification after the biopsy was taken
 

Name: Dr. Lucien Widmer & Dr. Carlo Tappero 


Institution: HFR hôpital fribourgeois, Fribourg (Switzerland)


Patient age and sex:  75 years, male


Initial condition:

  • The patient came to the emergency because he fell frontally on the head probably due to a vasovagal collapse from abdominal pain
  • Therefore, a CT was performed which showed a non-homogeneous mass (51x22mm) with a hypodense centre located in the liver hilum
  • CRP and murphy sign were negative
  • Two days later in the tumour board the conclusion was to take a biopsy to get a result from the mass. Differential diagnosis was lymphoma/carcinoma

Treatment: 

  • A previous attempt with ultrasound guidance failed and therefore a biopsy under general anaesthesia with high frequency jet ventilation and the support of CAS-One was considered
  • Planning showed only one possible pathway to the suspected lesion, without either passing through the portal vein or puncturing the gallbladder
  • Because of the precision required CAS-One IR was used for navigation
  • Biopsy was performed with 16G co-axial system with a 18G biopsy needle

Result:

  • Three cylinders were taken from suspected mass
  • A small bleeding appeared on the post-biopsy scan, however, the following late phase (and angiogram after) showed tamponade
  • It was hypothesed that during the biopsy, even though there was a safe distance from the hepatic arteria, a small branch of it was hit
  • The pathology shows a carcinoma with little differential, expressing CDX2 which means it is probably pancreatic-biliary origin

Learn more about the stereotactic navigation system CAS-One IR.

 

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