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Yoen H, Chung HA, Lee SM, Kim ES, Moon WK, Ha SM. Hemorrhagic Complications Following Ultrasound-Guided Breast Biopsy: A Prospective Patient-Centered Study. Korean J Radiol 2024; 25:157-165. [PMID: 38288896 PMCID: PMC10831294 DOI: 10.3348/kjr.2023.0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE We aimed to evaluate the clinical and imaging factors associated with hemorrhagic complications and patient discomfort following ultrasound (US)-guided breast biopsy. MATERIALS AND METHODS We prospectively enrolled 94 patients who were referred to our hospital between June 2022 and December 2022 for US-guided breast biopsy. After obtaining informed consent, two breast radiologists independently performed US-guided breast biopsy and evaluated the imaging findings. A hemorrhagic complication was defined as the presence of bleeding or hematoma on US. The patients rated symptoms of pain, febrile sensation, swelling at the biopsy site, and dyspnea immediately, 20 minutes, and 2 weeks after the procedure on a visual analog scale, with 0 for none and 10 for the most severe symptoms. Additional details recorded included those of nausea, vomiting, bleeding, bruising, and overall satisfaction score. We compared the clinical symptoms, imaging characteristics, and procedural features between patients with and those without hemorrhagic complications. RESULTS Of 94 patients, 7 (7%) developed hemorrhagic complications, while 87 (93%) did not. The complication resolved with 20 minutes of manual compression, and no further intervention was required. Vascularity on Doppler examination (P = 0.008), needle type (P = 0.043), and lesion location (P < 0.001) were significantly different between the groups. Patients with hemorrhagic complications reported more frequent nausea or vomiting than those without hemorrhagic complications (29% [2/7] vs. 2% [2/87], respectively; P = 0.027). The overall satisfaction scores did not differ between the two groups (P = 0.396). After 2 weeks, all symptoms subsided, except bruising (50% 2/4 in the complication group and 25% [16/65] in the no-complication group). CONCLUSION US-guided breast biopsy is a safe procedure with a low complication rate. Radiologists should be aware of hemorrhagic complications, patient discomfort, and overall satisfaction related to this procedure.
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Affiliation(s)
- Heera Yoen
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Ah Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Sung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Turgut B, Bakdik S, Öncü F, Küçükosmanoğlu İ, Eren Karanis Mİ, Kerimoğlu RS, Saraçoğlu M. Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions. Ultrasound Q 2023; 39:109-116. [PMID: 36856702 DOI: 10.1097/ruq.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
ABSTRACT In this study, it was aimed to contribute to the selection of the method to perform pancreatic lesion biopsies.Data of patients, who had undergone a percutaneous biopsy because of pancreatic masses in our institution in the period between January 2015 and November 2019, were evaluated retrospectively. The percutaneous biopsy method, the type of needle used in the procedure, and periprocedural complications were listed. Pathology and cytology reports in the archive were reviewed, and biopsy results were divided into 3 groups as benign, malignant, and inadequate. Of 308 patients included in the study, the diagnostic accuracy was verified in 124 patients through the assessment of surgical outcomes, results of biopsies from metastatic lesions, or follow-up findings. The verified results were classified as true-positives and true-negatives.Of a total of 308 patients included in the study, 23 underwent a fine-needle aspiration biopsy (FNAB) and 285 underwent a core needle biopsy (CNB). No statistical differences were observed in sample acquisition success and complications between the groups.Of the lesions with a confirmed pathological diagnosis, 67.74% were malignant and 32.26% were benign. The diagnosis was correct in 107 of 112 CNB patients (95.54%) and 9 of 12 FNAB patients (75.00%). When the success of the 2 methods was compared, it was found that outcomes of CNB were statistically more successful compared with those of FNAB.A transabdominal ultrasound-guided percutaneous CNB is a safe method with a high diagnostic yield to perform a biopsy of the pancreas.
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Affiliation(s)
- Bekir Turgut
- Department of Radiology, University of Necmettin Erbakan, Meram Medical Faculty Hospital, Konya
| | - Süleyman Bakdik
- Department of Radiology, University of Necmettin Erbakan, Meram Medical Faculty Hospital, Konya
| | - Fatih Öncü
- Department of Radiology, University of Gazi, Medical Faculty Hospital, Ankara
| | | | | | - Ramazan Saygin Kerimoğlu
- Department of gastroenterology surgery, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Mustafa Saraçoğlu
- Department of gastroenterology surgery, University of Health Sciences, Konya City Hospital, Konya, Turkey
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Loving VA, Johnston BS, Reddy DH, Welk LA, Lawther HA, Klein SC, Cranford CM, Reed RC, Rangan P, Morris MF. Antithrombotic Therapy and Hematoma Risk during Image-guided Core-Needle Breast Biopsy. Radiology 2023; 306:79-86. [PMID: 35997610 DOI: 10.1148/radiol.220548] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background For image-guided core-needle breast biopsy (CNBB), it remains unclear whether antithrombotic medication should be withheld because of hematoma risk. Purpose To determine hematoma risk after CNBB in patients receiving antithrombotic medication and to stratify risk by antithrombotic type. Materials and Methods This HIPAA-compliant retrospective study included US-, stereotactic-, or MRI-guided CNBBs performed across six academic and six private practices between April 2019 and April 2021. Patients were instructed to continue antithrombotic medications, forming two groups: antithrombotic and nonantithrombotic. Hematomas were defined as new biopsy-site masses with a diameter of 2 cm or larger on postprocedure mammograms. Hematomas were considered clinically significant if management involved an intervention other than manual compression. Patient age, type of antithrombotic medication, practice type, image guidance modality, needle gauge and type, and outcome of pathologic analysis were recorded. Multivariable logistic regression analysis was used to analyze variables associated with hematomas. Results A total of 3311 biopsies were performed in 2664 patients (median age, 60 years; IQR, 48-70 years; 2658 women). The nonantithrombotic group included 2788 biopsies, and the antithrombotic group included 523 biopsies (328 low-dose aspirin, 73 full-dose antiplatelet drugs, 51 direct oral anticoagulants, 36 warfarin, 32 daily nonsteroidal anti-inflammatory drugs, three heparin or enoxaparin). The antithrombotic group had a higher overall hematoma rate (antithrombotic group: 49 of 523 biopsies [9.4%], nonantithrombotic group: 172 of 2788 biopsies [6.2%]; P = .007), but clinically significant hematoma rates were not different (antithrombotic group: two of 523 biopsies [0.4%], nonantithrombotic group: one of 2788 biopsies [0.04%]; P = .07). At multivariable analysis, age (odds ratio [OR], 1.02; 95% CI: 1.01, 1.03; P < .001), 9-gauge or larger needles (OR, 2.1; 95% CI: 1.28, 3.3; P = .003), and full-dose antiplatelet drugs (OR, 2.5; 95% CI: 1.29, 5.0; P = .007) were associated with higher hematoma rates. US guidance (OR, 0.26; 95% CI: 0.17, 0.40; P < .001) and 10-14-gauge needles (OR, 0.53; 95% CI: 0.36, 0.79; P = .002) were predictive of no hematoma. Conclusion Because clinically significant hematomas were uncommon, withholding antithrombotic medications before core-needle breast biopsy may be unnecessary. Postbiopsy hematomas were associated with full-dose antiplatelet drugs, patient age, and 9-gauge or larger needles. No association was found with other types of antithrombotic medication. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chang and Yoen in this issue.
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Affiliation(s)
- Vilert A Loving
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Brian S Johnston
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Denise H Reddy
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Leslie A Welk
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Hannah A Lawther
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Shayna C Klein
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Caroline M Cranford
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - R Christopher Reed
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Pooja Rangan
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
| | - Michael F Morris
- From the Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Dr, Suite 150, Gilbert, AZ 85234 (V.A.L., B.S.J., D.H.R., L.A.W., H.A.L., S.C.K., M.F.M.); Banner Imaging, Glendale, Ariz (C.M.C.); Radiology Imaging Associates, Englewood, Colo (R.C.R.); Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine (P.R.), and Department of Radiology (M.F.M.), Banner-University Medical Center Phoenix, Phoenix, Ariz
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Image-guided Percutaneous Biopsy of the Liver. Tech Vasc Interv Radiol 2021; 24:100773. [PMID: 34895710 DOI: 10.1016/j.tvir.2021.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Percutaneous Biopsy of the Liver (PBL) is a cornerstone in the diagnosis of parenchymal liver disease and focal hepatic lesions. The indications for PBL can broadly be divided into those used to garner information regarding diagnosis, prognosis, or treatment. While the diagnosis of many common liver diseases can usually be made with imaging and serologic testing alone, PBL may be indicated in situations where the diagnosis is in question. Furthermore, liver biopsies are a foundational element for personalized treatment approaches for cancer patients; increasing emphasis is being placed on acquiring sufficient tissue for molecular profiling. While a variety of image guidance and procedural techniques have been applied to PBL, following conventional principles can ensure technical success and minimize complication risks. In this technique article, we review the practical periprocedural considerations of PBL with emphasis on recent advancements and societal recommendations.
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Takhar P, Motilal B, Savita A. Malpositioning of central venous catheter from right to left subclavian vein: A rare complication. Indian J Crit Care Med 2017; 21:799-801. [PMID: 29279646 PMCID: PMC5699013 DOI: 10.4103/0972-5229.218155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Invasive monitoring with central venous catheter (CVC) is a valuable tool now a day in Intensive Care Units and in postoperative hemodynamically unstable patients. It is often employed for administering medications and parenteral nutrition. In most of the instances, these catheters are inserted using proper topographical landmarks and ultrasonography-guided methods. Central venous cannulation is associated now and then with unexpected complications despite the use of all precautions and help of imaging techniques. There is a wide variety of complications related to the central venous cannulation including malpositioning. Malpositioning of the catheter into contralateral subclavian is an extremely unusual event. Here, we report a rare case of malpositioning of CVC from the right to the left subclavian vein also we outline how the misplacement was identified and effectively managed.
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Baz AA, Gad AM, Waly MR. Ultrasound guided injection of platelet rich plasma in cases of chronic plantar fasciitis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim JW, Shin SS. Ultrasound-Guided Percutaneous Core Needle Biopsy of Abdominal Viscera: Tips to Ensure Safe and Effective Biopsy. Korean J Radiol 2017; 18:309-322. [PMID: 28246511 PMCID: PMC5313519 DOI: 10.3348/kjr.2017.18.2.309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/09/2016] [Indexed: 12/13/2022] Open
Abstract
Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications.
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Affiliation(s)
- Jin Woong Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea.; Center for Aging and Geriatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea
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Hebard S, Hocking G, Murray K. Two-Dimensional Mapping to Assess Direction and Magnitude of Needle Tip Error in Ultrasound-Guided Regional Anaesthesia. Anaesth Intensive Care 2011; 39:1076-81. [DOI: 10.1177/0310057x1103900615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed whether echogenic needles reduce tip location error, by comparing three echogenic designs (Pajunk Sonoplex, Lifetech, B. Braun Stimuplex D+) with a non-echogenic control (Pajunk Uniplex), using a novel assessment technique in unembalmed human cadavers. Multiple images were taken of each needle at shallow (15 to 25°), moderate (35 to 45°) and steep (55 to 65°) insertion angles. Twenty anaesthetists with varied experience in ultrasound-guided nerve blocks identified needle tip position and stated their confidence level in estimates. Actual tip position was determined at the time of image generation but concealed from the anaesthetists. Two-dimensional mapping of ‘tip-error’ involved measurement of the distance and orientation of each clinician's estimate of tip position in relation to the actual tip position. There were no significant differences in confidence or overall needle visibility at shallow insertion angles. At steeper angles, the Sonoplex showed significantly higher confidence and visibility scores. The remaining echogenic designs did not show any significant differences from the non-echogenic control. Objective measurements of tip error followed the same pattern as the subjective data, although were not universally significant. Two-dimensional mapping showed that as needle visibility deteriorated, so precise tip location was lost but the needle shaft/insertion path remained well-identified. As visibility deteriorated further, accuracy in this axis was also lost. When inaccurate, clinicians generally assessed the needle tip to be more superficial and inserted less far than it actually was. This has important implications for the safety of ultrasound-guided regional anaesthesia. Effective echogenic needle technology has the potential to address these concerns.
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Affiliation(s)
- S. Hebard
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - G. Hocking
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - K. Murray
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
- School of Mathematics and Statistics, The University of Western Australia
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Tzeng BC, Wang CJ, Huang SW, Chang CH. Doppler Ultrasound-guided Percutaneous Nephrolithotomy: A Prospective Randomized Study. Urology 2011; 78:535-9. [DOI: 10.1016/j.urology.2010.12.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 12/18/2010] [Accepted: 12/21/2010] [Indexed: 11/16/2022]
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del Cura JL. Ultrasound-guided therapeutic procedures in the musculoskeletal system. Curr Probl Diagn Radiol 2008; 37:203-18. [PMID: 18662599 DOI: 10.1067/j.cpradiol.2007.08.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for small or poorly accessible lesions and joints and for obese patients. Drainage can be performed using catheters or needles and can avoid a more aggressive approach most of the time. Intracavitary urokinase helps when the aim is to drain clotted hematomas or fibrinous collections. Injection of corticoids is useful in the treatment of ganglia, Baker's cysts, tendinitis, and noninfected arthritis. Calcific tendinitis of the shoulder can be effectively treated using percutaneous "lavage" with lidocaine. Calcifications usually disappear and symptoms improve in nearly 90% of the cases within a year. Most of these techniques are low cost and require only a moderate skill. Ultrasound-guided procedures are useful tools to effectively treat some diseases of the musculoskeletal system and should be routine in any imaging department.
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Kim KW, Kim MJ, Kim HC, Park SH, Kim SY, Park MS, Kim TK. Value of "patent track" sign on Doppler sonography after percutaneous liver biopsy in detection of postbiopsy bleeding: a prospective study in 352 patients. AJR Am J Roentgenol 2007; 189:109-16. [PMID: 17579159 DOI: 10.2214/ajr.07.2071] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the prevalence of the "patent track" sign on Doppler sonography after percutaneous liver biopsy and to assess its value in detection of postbiopsy bleeding. SUBJECTS AND METHODS The study group included 352 patients who underwent Doppler sonography after 361 percutaneous liver biopsies. Color-flow images were obtained immediately and 5 minutes after the biopsies. Images were evaluated for the patent track sign, defined as linear color flow along the needle path. Patients were followed-up with clinical and laboratory findings to search for postbiopsy bleeding. Those suspected of having postbiopsy bleeding underwent CT. Sonographic results were compared with clinical and CT findings. RESULTS Clinically significant postbiopsy bleeding occurred in five patients (1%). On Doppler sonography immediately after the biopsies, the patent track sign was seen in 43 patients (12%). Patients with this sign more frequently bled than those without it (p = 0.0008). Sensitivity, specificity, positive predictive values, and negative predictive values in detection of postbiopsy bleeding were 80%, 89%, 9%, and 100%, respectively. Among these patients, this sign was persistently seen in four and disappeared in the remaining 39 at 5 minutes after the biopsies. Patients with a persistent patent track sign more frequently bled than those without it (p < 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 100%, 75%, and 99%, respectively. CONCLUSION A patent track sign, frequently seen on Doppler sonography immediately after percutaneous liver biopsy, provides excellent screening for postbiopsy bleeding. This sign strongly predicts postbiopsy bleeding when persistently seen for 5 minutes.
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Affiliation(s)
- Kyoung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-ku, Seoul 138-736, Korea.
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Coley BD, Hogan MJ. Image-guided interventions in neonates. Eur J Radiol 2006; 60:208-20. [PMID: 16962732 DOI: 10.1016/j.ejrad.2006.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 07/10/2006] [Accepted: 07/12/2006] [Indexed: 01/28/2023]
Abstract
Minimally invasive interventional radiological procedures can be invaluable in the care of neonates and infants. These procedures have proven to be useful in a wide variety of clinical situations, improving patient care, comfort and safety. Most techniques in adult interventional radiology have been adapted for use in pediatric patients, covering the spectrum of diagnostic and therapeutic intervention. Procedural techniques are similar, but require considerations of patient size, sedation, and support personnel in order to render optimal care. Proper physician training is imperative to provide the necessary confidence and expertise, and post-procedural follow-up is required to maximize positive outcomes. This paper discusses many of the procedures that may be performed in neonates, and offers suggestions and techniques for successful outcomes.
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Affiliation(s)
- Brian D Coley
- Department of Radiology, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Beagle GL. Bedside diagnostic ultrasound and therapeutic ultrasound-guided procedures in the intensive care setting. Crit Care Clin 2000; 16:59-81. [PMID: 10650500 DOI: 10.1016/s0749-0704(05)70097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The availability, portability, safety, and other features of ultrasound have ushered this relatively new imaging modality into the everyday clinical practice of multiple disciplines. Features unique to ultrasound lend this imaging modality the opportunity for extensive use in the ICU. A review of its uses in this capacity includes bedside diagnosis of common disorders seen in the ICU setting, such as DVT, cholecystitis, and abscess. Bedside sonography also can aid in the treatment of such disorders, including DGC of pseudoaneurysms, fluid aspirations, and abscess drainages. This article is a review and could not possibly cover all bedside uses of ultrasound or provide in-depth information of specific uses described in this article. Hopefully, this article will spark an interest and prove as a starting point on a rewarding learning adventure.
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Affiliation(s)
- G L Beagle
- Department of Diagnostic Radiology, Oregon Health Sciences University, Portland, USA
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Cardinal E, Chhem RK, Beauregard CG. Ultrasound-guided interventional procedures in the musculoskeletal system. Radiol Clin North Am 1998; 36:597-604. [PMID: 9597077 DOI: 10.1016/s0033-8389(05)70048-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ultrasound is a low-cost, nonionizing, readily available diagnostic technique for the evaluation of tendons, muscles, soft tissue masses, cysts, and other fluid collections. Ultrasound is also a valuable tool for guiding a variety of musculoskeletal interventions. Procedures that can be performed under ultrasound guidance include aspiration of fluid for analysis, injection for medication, decompression of cysts, drainage of abscess and hematoma, biopsy, treatment of calcified tendinitis, and foreign body retrieval.
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Affiliation(s)
- E Cardinal
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Pavillon Saint-Luc, Montreal, Quebec, Canada.
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Nemcek AA. The use of ultrasound as an adjunct to the performance of vascular procedures. J Vasc Interv Radiol 1996; 7:869-75. [PMID: 8951755 DOI: 10.1016/s1051-0443(96)70865-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- A A Nemcek
- Northwestern Memorial Hospital, Department of Radiology, Chicago, IL 60611, USA
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Jaques PF, Campbell WE, Dumbleton S, Mauro MA. The first rib as a fluoroscopic marker for subclavian vein access. J Vasc Interv Radiol 1995; 6:619-22. [PMID: 7579874 DOI: 10.1016/s1051-0443(95)71147-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To determine whether the anatomic relationship between the subclavian vein (SCV) and the first rib is sufficiently constant to allow safe and reproducible fluoroscopically guided SCV puncture. MATERIALS AND METHODS Forty-four subclavian venograms were obtained from 42 consecutive adult patients. Position and width of the SCV crossing over the first rib were recorded by using radial coordinates. Based on this anatomic study, 42 SCV access procedures were performed with use of the first rib as a fluoroscopic marker. Technical success, complications, number of 21-gauge needle passes, physician experience, and patients' body habitus were recorded. RESULTS Mean angular position of SCV/first rib crossover was 94.7 degrees (standard deviation [SD], 7.42 degrees). Mean radial width of the SCV was 14.9 degrees (SD, 3.1 degrees). On 25 of the 44 subclavian venograms (60%), the SCV/first rib crossover lay within the 90 degrees-99 degrees segment, and on 36 of 44 (82%) it lay within the 85 degrees-104 degrees segment. Technical success in accessing the SCV was 100% (42 of 42 procedures). Two minor complications involved subclavian artery puncture with the 21-gauge needle without sequelae. The mean number of needle passes required was 2.86 (median, 1.7). There was no correlation between needle passes and patients' body habitus or physician experience. CONCLUSION The SCV is reliably constant in its relation to the first rib. The first rib alone provides a reliable fluoroscopic marker for safe SCV access without the need for ultrasound guidance or peripheral contrast material administration.
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Affiliation(s)
- P F Jaques
- Department of Radiology, School of Medicine, University of North Carolina, Chapel HIll 27599-7510, USA
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