Usefulness of sonographic guidance during percutaneous biopsy of mesenteric masses

Percutaneous image-guided mesenteric biopsy: how we do it in a high-volume training center

Lesions in the mesentery are unique from other potential biopsy targets in the abdomen or pelvis for several reasons. Mesenteric lesions are among the deepest in the abdomen and are often surrounded by or adjacent to small bowel or colon. Mesenteric vasculature is often crowded, and traversing the mesentery often involves crossing multiple vascular planes. Mesenteric lesions and the structures surrounding them within the peritoneal cavity are often highly mobile. All these features can be daunting to any radiologist asked to perform a mesenteric biopsy. We provide a comprehensive overview and guide to percutaneous mesenteric biopsy informed by available literature and experience at two high volume teaching centers. Topics covered include the pitfalls of using prior imaging to determine whether mesenteric biopsy is possible, techniques specific to US or CT-guidance and complications including hemorrhage and bowel injury.

Factors influencing diagnostic yield in ultrasound-guided omental biopsies: insights from a retrospective study

PURPOSE

To evaluate the safety, diagnostic accuracy, and factors influencing the diagnostic yield of ultrasound (US)-guided omental biopsies.

MATERIALS AND METHODS

This retrospective study included 109 patients who underwent US-guided omental biopsies between June 2020 and June 2024. Pre-biopsy diagnostic images (CT, MRI, or [18 F]FDG PET/CT) were reviewed. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and adverse events were evaluated. Surgical or clinical diagnoses with follow-up served as the diagnostic reference standard. Associations between diagnostic yield and findings on pre-biopsy imaging and biopsy US were explored.

RESULTS

The study achieved a technical success rate of 100%. Initial biopsy results showed a sensitivity of 82.6%, specificity of 100%, PPV of 100%, NPV of 60.5%, and diagnostic accuracy of 86.2%. The pre-biopsy imaging modality was not related to diagnostic accuracy. Ascites interposition on the puncture route was significantly higher in patients without diagnostic accuracy (73.3% vs. 30.9%, p = 0.002). Deeper lesions exhibited lower diagnostic accuracy (p = 0.003). No major or minor complications were associated with the biopsies.

CONCLUSION

Percutaneous omental biopsy is an effective and safe method for evaluating omental abnormalities. Depth from the needle entry site and the presence of ascites along the puncture route were identified as factors affecting diagnostic accuracy. The choice of imaging modality did not impact diagnostic outcomes, highlighting the importance of lesion-specific factors in the planning of biopsies.

Image-guided percutaneous mesenteric biopsy: diagnostic yield and safety profile

PURPOSE

To evaluate the diagnostic yield and safety profile of percutaneous image-guided biopsy of mesenteric lesions.

MATERIALS, METHODS, AND PROCEDURES

Image-guided percutaneous biopsies of the mesentery at a single institution from 2000 to 2022 were identified and reviewed. Relevant demographic and procedural data were abstracted from the medical record. Surgical pathology was reviewed to evaluate if the biopsy was diagnostic and concordant with the patient's final diagnosis.

RESULTS

One hundred ninety five patients (mean age, 62.6 ± 14.; M/F, 113/82; mean BMI, 30.4) underwent mesenteric biopsy procedure. Of these, 173 (89%) were performed using ultrasound and 22 (11%) were performed using CT or a hybrid/combined approach. Core needle biopsy was used in 164 (84%) patients, fine-needle aspiration (FNA) was used in 21 (11%), and both were used 10 (5%). Mean/median number of biopsy passes was 2.8 ± 1.3 and 3, respectively (core mean 2.7 ± 1.2; FNA mean 3.4 ± 1.5). Average lesion size was 5.3 ± 4.4 cm in the long axis and 2.9 ± 2.0 cm in the target plane. Diagnostic yield of core biopsies was 97.7% (n = 170/174) and FNA was 80.6% (n = 25/31) for an overall combined yield of 96.4% (n = 188/195). Of diagnostic biopsies, 95.7% (n = 180/188) were concordant with the final diagnosis, 70.8% (n = 138) of which were considered malignant. Overall concordant diagnostic rate was 180/195 (92.3%). Neuroendocrine tumor pathology was the only factor associated with lower diagnostic yield (13/15, 87%). For all biopsies, average shortest skin-to-target-distance on CT was 6.3 ± 2.8 cm, decreased to 4.1 ± 1.3 cm with US compression (approximately 35% reduction, p < 0.001). Additionally, ultrasound created a safe path not available on CT in 29 (15%) biopsies. Moderate IV sedation was used in 91.3% (n = 178) of mesenteric procedures. Complications occurred in 11 (5.6%) biopsies, and all were considered minor.

CONCLUSION

This represents a large cohort of image-guided percutaneous biopsies of mesenteric lesions with the majority representing core biopsy performed under US guidance. This technique offers high diagnostic yield and a favorable safety profile for tissue diagnosis. Furthermore, compression with ultrasound reduced skin-to-target distance by 35% and created a biopsy path that would not be possible on CT in 15% of US cases.

Determination of the diagnostic accuracy of peritoneal biopsy with an 18G cutting needle under ultrasonography guidance and the contribution of CT findings to diagnosis before biopsy (our 8-year clinical experience)

AIM

Ultrasound-guided percutaneous core needle biopsy is an important technique in diagnosing mesenteric involvement. Diagnostic results were compared with pre-biopsy CT findings. The purpose of this study was to determine the diagnostic efficiency of omental lesion biopsies performed under ultrasound guidance and to investigate the relationship between pre-biopsy diagnostic CT findings.

MATERIALS AND METHODS

Demographic data of 70 patients who underwent omental biopsy under ultrasound guidance in our clinic between August 2015 and July 2023, the presence of a primary malignancy focus during the investigations conducted during the research, biopsy histopathology results, and pre-biopsy CT findings were retrospectively reviewed.

RESULTS

This retrospective study included who underwent omental biopsy under ultrasound guidance, 48 (69%) were female, and 22 (31%) were male, with an average age of 61 (age range 15-95), and an average body mass index [BMI] of 27.7 ± 6.9. Five (7%) of the 70 biopsy procedures were not pathologically diagnostic. Diagnostic results were compared with pre-biopsy CT findings. In all omental lesions, the percentage of omental infiltrative involvement in diagnostic CT was subjectively evaluated by two radiologists. 65 patients diagnosed pathologically, 47 (67%) were malignant, and 18 (26%) were benign. No complications occurred.

CONCLUSION

Peritoneal biopsies under ultrasound guidance for mesenteric diseases detected on CT are a reliable procedure that can be easily applied. Ultrasonography imaging helps identify appropriate locations for targeted biopsies before deep percutaneous biopsy, increasing diagnostic accuracy, especially when omental lesions appear as infiltrative thickenings.

Ultrasound-Guided Omental Biopsy: Diagnostic Yield and Association With CT Features Based on a Single-Institution 18-Year Series

BACKGROUND. The greater omentum can serve as a useful target for percutaneous biopsy; in clinical practice, CT is commonly used for biopsy guidance. OBJECTIVE. The purpose of this study was to evaluate the diagnostic yield of percutaneous ultrasound (US)-guided omental biopsy and to explore the association of the diagnostic yield with prebiopsy diagnostic CT findings. METHODS. This retrospective study included 163 patients (120 women and 43 men; mean age, 65 ± 12 [SD] years; mean body mass index [BMI], 28.9 ± 7.9) who underwent US-guided omental biopsy between 2002 and 2020 at a single institution at which US served as the first-line modality for omental biopsy guidance. Biopsies were performed by abdominal radiologists without dedicated interventional radiology fellowship training. Postbiopsy clinical follow-up and imaging follow-up were reviewed to establish the ultimate diagnosis for each patient. Omental biopsies were characterized as diagnostic or nondiagnostic relative to the ultimate diagnosis. Associations were explored between diagnostic yield and findings on prebiopsy CT and biopsy US. RESULTS. US-guided omental biopsy was performed using an 18-gauge core needle biopsy technique in 156 patients and fine-needle aspiration in seven patients. The mean number of biopsy passes was 2.5 ± 1.0, and mean omental thickness near the biopsy site on CT was 2.6 ± 1.2 cm. On prebiopsy diagnostic CT, omental disease appeared infiltrative in 127 (78%) patients versus mass-forming in 36 (22%) and appeared hypoechoic in 105 (64%) patients versus iso- to hyperechoic in 58 (36%). The ultimate diagnosis was malignant tumor in 154 (95%) patients (most commonly, gynecologic tumors in 82 patients [high-grade serous adenocarcinoma in 56] and gastrointestinal tumors in 45 patients) and a benign finding in nine (6%) patients. The omental biopsy was diagnostic relative to the ultimate diagnosis in 155 (95%) patients. A diagnostic versus nondiagnostic biopsy was not associated (p > .05) with age, BMI, number of biopsy passes, or omental target thickness or attenuation. A total of 94% (120/127) of US-guided omental biopsies of infiltrative cases and 97% (35/36) of biopsies of mass-forming cases were diagnostic (p = .50). A total of 96% (102/106) of US-guided omental biopsies of hypoechoic cases and 93% (53/57) of biopsies of iso- to hyperechoic cases were diagnostic (p = .36). No complications occurred. CONCLUSION. US-guided biopsy of omental disease suspected on CT is safe and effective for tissue diagnosis. Although omental disease commonly appears on US as diffuse infiltrative thickening without a discrete target, sampling based on prebiopsy CT landmarks is diagnostic in most cases. CLINICAL IMPACT. US should be considered the first-line modality for omental biopsy guidance when feasible.

Comparative Study of Ultrasound-guided Percutaneous Omental Biopsy in Cirrhotics and Noncirrhotics

BACKGROUND

To evaluate the safety and efficacy of ultrasound-guided (US-guided) omental biopsy in patients with liver cirrhosis and compare these with the noncirrhotic patients.

METHODS

We retrospectively studied the US-guided omental biopsies (73 males, 14 females with mean age 52.71 ± 15.90 y) between January 2012 and December 2018. Patients with biopsy-proven liver cirrhosis (n = 31) who underwent omental biopsy were included in Group 1, and patients without any features of the chronic liver disease (n = 56) were included in Group 2. The technical success, diagnostic parameters, complications, imaging appearance, and histopathology spectrum were compared between the two groups. Also, univariate analysis was done to evaluate the association of a parameter with histopathology.

RESULTS

The technical success, sample adequacy, diagnostic accuracy of Group 1 were 100%, 96.77%, and 96.77%, respectively, and for Group 2, these were 100%, 98.21%, and 98.21%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value of Group 1 were 95%, 100%, 100%, 91.67%, respectively, and for Group 2, these were 97.92%, 100%, 100%, 88.89%, respectively. There was one complication of abdominal wall hematoma in Group 1 (3.2%), which was managed conservatively. Smudged imaging appearance and nonspecific inflammation on histopathology were more common in Group 1, and there was a significant association of increased omental thickening with specific pathology in Group 1.

CONCLUSION

US-guided omental biopsy in patients with liver cirrhosis is safe and effective with comparable results to noncirrhotic patients.

Biopsy of Deep Pelvic and Abdominal Targets With Ultrasound Guidance: Efficacy of Compression

OBJECTIVE. The purpose of this study was to evaluate the utility of compression of tissues with the ultrasound transducer in decreasing distance to the biopsy target and establishing a safe percutaneous biopsy route to deep abdominopelvic targets. MATERIALS AND METHODS. Ultrasound-guided biopsies of nonsolid organ abdominopelvic targets performed from 2006 to 2017 were reviewed. Skin-to-target distance was measured on preprocedure CT scans for reference standard and on procedure ultrasound images for actual real-time distance after compression. The skin-to-target CT distance groupings were 0-3 cm, 3-6 cm, 6-10, cm, and > 10 cm. Deep targets were defined as > 6 cm. Differences in skin-to-target distance between static CT and compression ultrasound were calculated. Body mass index, procedure details, diagnostic yield, and complication rate were recorded. RESULTS. The biopsies of 389 patients (167 men, 222 women; mean age, 62.4 years; mean body mass index, 28.2) were assessed. Skin-to-target distance was 0-3 cm in 108 patients, 3-6 cm in 163 patients, 6-10 cm in 99 patients, and > 10 cm in 19 patients. A total of 118 deep targets were identified. The mean skin-to-target distance in the entire cohort was 5.0 cm on CT scans and 3.6 cm on ultrasound images with a 10% mean decrease in distance with ultrasound compression. For skin-to-target distances of 6-10 cm, distance decreased 39% at ultrasound, and for skin-to-target distances > 10 cm, distance decreased 48%. Thirty-three patients (8.5%) had no safe identifiable path for CT biopsy, most commonly because of intervening bowel, displacement of which at ultrasound allowed a safe biopsy trajectory. Ultrasound-guided biopsy had a diagnostic yield of 91.5% and a favorable safety profile. The complication rate was 1.3%. CONCLUSION. Application of compression with the ultrasound transducer decreased skin-to-target distance 40% or more for deep targets in addition to displacing bowel and establishing a safe path for biopsy in approximately 8.5% of cases.

Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum

OBJECTIVE

To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum.

MATERIAL AND METHODS

We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign / malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement).

RESULTS

All (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death).

CONCLUSION

Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur.

Intra-abdominal fat. Part III. Neoplasms lesions of the adipose tissue

This article focuses on various cancerous lesions that are found beyond organs in the intra-abdominal fat and can be visualized with ultrasonography. These lesions are divided into five groups. The first group includes primary benign tumors containing adipocytes, such as lipoma, lipoblastoma, hibernoma and other lesions with an adipose tissue component, such as myolipoma, angiomyolipoma, myelolipoma and teratoma. The second group comprises primary malignant adipocytecontaining tumors, including liposarcoma and immature teratoma. The third group contains primary benign tumors without an adipocyte component that are located in intra-abdominal fat. This is a numerous group of lesions represented by cystic and solid tumors. The fourth group encompasses primary malignant tumors without an adipocyte component that are located in intra-abdominal fat. These are rare lesions associated mainly with sarcomas: fibrosarcoma, malignant fibrous histiocytoma, hemangiopericytoma and leiomyosarcoma. An epithelioid tumor at this site is mesothelioma. The last but not least group includes secondary malignant tumors without an adipocyte component located in intra-abdominal fat. This is the most numerous group with prevailing carcinoma foci. For each of these groups, the authors present ultrasound features of individual lesions and discuss their differential diagnosis. In the vast majority of cases, the material for cytological and histological analysis can be obtained during ultrasound-guided procedures. This is the advantage of this imaging modality.

Trans-organ versus trans-mesenteric computed tomography-guided percutaneous fine-needle aspiration biopsy of pancreatic masses: feasibility and safety

AIM

To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous fine-needle aspiration biopsy (FNAB) of pancreatic masses that traverses the gastrointestinal tract or solid viscera.

MATERIALS AND METHODS

From January 2002 to December 2012, 144 patients underwent 165 CT-guided biopsies of pancreatic masses. Biopsies were performed using a 21 or 22 G needle. Cytology reports, medical records, and procedure details for all patients were retrospectively reviewed to evaluate the biopsy route, complications, and diagnostic accuracy.

RESULTS

Trans-organ biopsies of pancreatic masses were safely performed via a direct pathway traversing the stomach (n = 45), colon (n = 14), jejunum (n = 4), or liver (n = 5). There were five self-limiting mesenteric haematomas along the biopsy route on immediate post-procedure CT and all patients remained asymptomatic. All haematomas occurred after a trans-mesenteric approach rather than passage through abdominal organs. Three patients had acute pancreatitis. There was no significant difference in complications and diagnostic yields between the groups. The sensitivity, specificity, positive predictive value, and negative predictive value of final FNAB cytology for malignancy were 98.3%, 100%, 100% and 71.4%, respectively. The overall accuracy was 98.4%.

CONCLUSION

Percutaneous FNAB using the trans-organ approach is a safe and effective technique to diagnose pancreatic malignancy.

Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin

BACKGROUND AND STUDY AIMS

Ascites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin.

PATIENTS AND METHODS

A total of 62 patients were prospectively enrolled; they underwent conventional (3.5-5MHz) and high-frequency (6-8MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive.

RESULTS

Ultrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported.

CONCLUSION

High-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin.

Mesenteric tumors: diagnosis and treatment

Mesenteric tumors are rare and consist of a heterogeneous group of lesions. Masses may arise from any of the mesenteric components: peritoneum, lymphatic tissue, fat, and connective tissue. Cellular proliferation can also arise from infectious or inflammatory processes. They can be classified as solid or cystic, benign or malignant. Mesenteric tumors are usually discovered incidentally or during investigation of non-specific symptoms. While clinical examination and imagery may suffice to make the diagnosis, histopathology is often required by either needle percutaneous or surgical biopsy, or immediate excision. Therapeutic management options vary widely depending on the nature of the lesion; they range from simple observation or medical therapy to surgery. Benign well-delineated mesenteric masses that are symptomatic can often be treated by simple enucleation. But invasive malignant tumors require a carcinologic resection; a careful preoperative evaluation to assess the relationship between the mass and adjacent vascular and digestive structures is essential since they may dictate the need for extensive sacrifice of bowel with resultant intestinal insufficiency due to short bowel syndrome.

Safety profile and technical success of imaging-guided percutaneous fiducial seed placement with and without core biopsy in the abdomen and pelvis

OBJECTIVE

The purpose of this study is to determine whether complications associated with combining biopsy and percutaneous fiducial seed placement in the abdomen and pelvis exceeds that of either procedure alone or prohibits completion of the combined procedure.

MATERIALS AND METHODS

A retrospective review was performed of 188 consecutive patients who underwent CT- or ultrasound-guided placement of fiducial seeds in the abdomen or pelvis, either alone (group 1, n = 117) or with concomitant biopsy (group 2, n = 71), from October 2005 through April 2010. Complications classified according to the Society of Interventional Radiology guidelines were compared between both groups using the Z test for proportions, as were the number of seeds per patient and seed migration and technical success rates.

RESULTS

One hundred eighty-eight patients underwent percutaneous placement of 533 fiducial seeds in the abdomen and pelvis. Eight patients (4.3%) had complications. Five were minor (four small hematomas and one pneumothorax) and three were major (two cases of bleeding and one of sepsis). There was no significant difference between groups with respect to minor complication rates, number of seeds placed per patient (p = 0.85), or technical success (p = 0.33). Significantly more major complications (p = 0.04) occurred in group 2, but the rate was similar to that for percutaneous biopsy alone as reported in the literature. Group 2 also had more seed migration (p = 0.02).

CONCLUSION

Biopsy and fiducial seed placement in the abdomen and pelvis can be performed in the same session rather than separately, with a high rate of technical success and without an increased risk of complications when compared with either procedure alone.

Ultrasound-guided biopsies in the abdomen and pelvis

Ultrasound-guided biopsies in the abdomen and pelvis are generally more effective, safer, faster, and cheaper than those performed under computed tomography guidance. This manuscript will discuss multiple aspects of sonographic biopsies performed between the diaphragm and the symphysis pubis. We begin with systems issues, patient preparation (including bleeding profile and anticoagulant use), pain management, and infection precautions. The procedure itself is then analyzed, including needle guidance, the role of the sonographer, image optimization, patient positioning, core- versus fine-needle aspiration, coaxial versus individual pass, needle technique, and postprocedure management. Issues specific to different sites are then discussed: liver, spleen, pancreas, kidney, adrenal, bowel, retroperitoneum and mesentery, and the pelvis. We finish with a discussion of complications, future trends, and a brief summary.

Ultrasound-guided biopsy of greater omentum: an effective method to trace the origin of unclear ascites

OBJECTIVES

Thickened greater omentum is encountered with high frequency in patients with ascites. The purpose of our study was to assess the utility of greater omentum biopsy under the guidance of ultrasound (US) in tracing the origin of unclear ascites and differentiating benign and malignant ascites.

MATERIALS AND METHODS

We retrospectively reviewed our institutional database for all records of greater omentum biopsy cases. One hundred and ninety-four patients with unclear ascites and thickened greater omentum were included in the study. The sonograms of greater omentum were evaluated before undergoing the ultrasound-guided biopsy and a biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist.

RESULTS

Successful biopsy was rendered for 182 biopsy procedures (93.8%, 182/194) including tuberculosis (n=114), chronic inflammation (n=3), metastases (n=58), malignant mesothelioma (n=6) and pseudomyxoma peritonei (n=1). Twelve biopsies were non-diagnostic. According to the results of biopsy and follow-up, the sensitivity and specificity of biopsy in distinguishing malignant ascites from benign ascities were respectively 95.6% (65/68) and 92.9% (117/126). The greater omentum of 84 cases of tuberculous peritonitis showed "cerebral fissure" sign and was well seen as an omental cake infiltrated with irregular nodules when involved by carcinomatosis. No "cerebral fissure" sign was observed in peritoneal carcinomatosis. The sensitivity and specificity of this sign in indicating the existence of tuberculous peritonitis were 73.5% (89/121) and 100% (73/73). Moreover, if the specific "cerebral fissure" sign was combined with the biopsy results, the specificity of biopsy in distinguishing malignant ascites from benign ascits increased to 96.8% (122/126).

CONCLUSION

Ultrasound-guided biopsy of greater omentum is an important and effective method to diagnose the unclear ascites for patients with thickened omentum if certain techniques could be paid attention to. "Cerebral fissure" sign of greater omentum was a specific sign in indicating the tuberculous peritonitis and could increase the specificity of biopsy in distinguishing malignant ascites from benign ascits if combined with the biopsy results.

Clinical outcome analysis of epiploon biopsy in the diagnosis of patients with tuberculous peritonitis

AIM: To evaluate the clinical practical value of epiploon biopsy in the diagnosis of tuberculous peritonitis.

METHODS: A total of 152 ascetic patients with uncertain diagnosis were selected to puncture the thickened peritoneum under the guidance of ultrasonic puncture probe. Biopsy tissue was sent for pathological examination. Serum PPD, ESR and CRP were and LDH in ascites were detected. Abdomen was examined by X-rays.

RESULTS: The success rate of epiploon biopsy was 96.05%. Of the 152 patients, 64 were diagnosed as tuberculous peritonitis, accounting for 42.11% of ascetic patients with uncertain diagnosis. The positive rate of epiploon biopsy was obviously higher than that of traditional clinical examinations. Serum ESR (χ² = 1.265, P = 0.261), PPD (χ² = 26.669, P = 0.000), CRP (χ² = 8.125, P = 0.004) and LDH in ascites (χ² = 20.403, P = 0.000) and positive findings of abdominal X-ray findings (χ² = 7.169, P = 0.007) were increased in tuberculous peritonitis patients with a significantly statistical difference (P < 0.05). Following pathologic findings of TB were observed in peritoneal tissue samples: cheese necrosis, Langhan's cells-like and epithelial cells-like multinucleated giant cells, a large number of fibers within adipose tissue.

CONCLUSION: Percutaneous biopsy can be confirmed tuberculosis peritonitis, secure, reliable, less restriction on the use, is one of the most practical clinical means of inspection.

Mesenteric hematoma mimicking a neoplasm—a case report

Mesenteric hematoma is an uncommon condition. A 24-year-old man who underwent surgery for retroperitoneal leiomyosarcoma presented 9 months later with upper abdominal mass. Computerized tomography revealed a mesenteric mass in relation to proximal ileum. With a diagnosis of tumor recurrence, exploratory laparatomy was carried out, and the mass was resected out. Histology revealed an organized hematoma.

Ultrasound-Guided Biopsies: Tricks, Needle Tips, and Other Fine Points

Ultrasound (US)-guided biopsy of thyroid nodules, abdominal masses, liver masses, random core liver biopsies, as well as aspiration of abdominal or pleural fluid is now routine practice. The ability of US to guide biopsy of abnormalities seen on cross-sectional imaging studies is well recognized as an efficient and effective means of achieving a tissue diagnosis. Its use requires basic knowledge of US image analysis, but clinically useful intuitive and nonintuitive methods can enhance its strengths. The purpose of this review is to provide a practical guide to some of these tricks that may be useful in everyday clinical practice.