To describe the role and technique of artificial pneumothorax as an ancilliary method in CT-guided percutaneous biopsy or thermal ablation of tumors located in the hepatic dome.
Hepatic dome is a challenging location for percutaneous interventions (Fig.1).
Ultrasound can be useful in approaching lesions due to it's non-axial dependance but is of limited value in visualization of deep seated lesions.
On the other hand, the limitation of CT is axial dependance which, for hepatic dome lesions, implies pulmonary parenchyma traversal and potential serious complications such as pneumothorax, hemothorax, alveolar bleeding, hemoptysis, tumor seeding, and severe postprocedural pain.
Artificial pneumothorax can create a safe and simple extrapulmonary transdiaphragmatic pathway for CT-guided hepatic dome...
Findings and procedure details
Thermal ablation is performed under deep sedation and local anesthesia, while percutaneous biopsy is performed in local anesthesia, only.
The needle entry site and path are planned after non-enhanced CT of the liver.
The entry site is cleansed with 2% chlorhexidine gluconate and sterilely draped.
After administration of local anesthesia, a small skin incision is made.
A spring-loaded insufflation needle (Veress needle) is inserted through the skin incision and advanced towards pleural space. As the needle enters the pleural cavity, a distinct click is heard...
Artificial pneumothorax is a simple and safe method that can be used in order to create a safe pathway for percutaneous CT-guided interventions in the hepatic dome.
Personal information and conflict of interest
E. Krešić; Zagreb/HR - nothing to disclose A. M. Alduk; Zagreb/HR - nothing to disclose M. Prutki; Zagreb/HR - nothing to disclose M. Cavka; Zagreb/HR - nothing to disclose I. Kuhtić; Zagreb/HR - nothing to disclose A. Marusic; Samobor/HR - nothing to disclose
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