---
title: CT-Guided Biopsy in a difficult Localisation in the Liver Hilum
description: Biopsy in the liver hilum with a difficult and long pathway to the suspected lesion without passing through the portal vein or puncturing the gallbladder
---

[CASCINATION Cases - Blog ](https://www.cascination.com/en/blog)

# [CT-Guided Biopsy in a difficult Localisation in the Liver Hilum](https://www.cascination.com/en/blog/ct-guided-biopsy-liver-hilum)

 Written by [Summar Yunas](https://www.cascination.com/en/blog/author/summaryunas) | December 22, 2020 9:08:00 AM Z

 

**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.**

 

 

 

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](https://www.h-fr.ch/), 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](https://www.cascination.com/products/cas_one_ir?hsLang=en).

 

 

[View full post](https://www.cascination.com/en/blog/ct-guided-biopsy-liver-hilum)

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