An initial experience of computed tomography-guided trans superior vena caval biopsy: a novel approach for precarious mediastinal lesions.

Purpose: As interventional radiologists, we encounter precarious deep-seated mediastinal lesions in our day-to-day practice. The conventional technique of percutaneous transthoracic biopsy of these lesions carries significant intrinsic complications. Endovascular approaches for such lesions under fluoroscopic guidance have been described in previous literature but with significant technical constraints. In this article, we would like to describe the novel approach of computed tomography (CT)-guided trans superior vena caval biopsy, which we have performed in 3 consecutive precarious mediastinal lesions. Material and methods: We placed a vascular sheath under ultrasound and fluoroscopic guidance considering the intended angle of needle puncture and length to reach the target lesion from the puncture site. With the sheath in situ, the trans superior vena caval biopsy was performed under CT guidance, and multiple cores of target tissue were safely and successfully obtained. Results: We have carefully and successfully employed this novel technique of CT-guided trans superior vena caval approach for 3 tricky deep-seated mediastinal lesions with very low risk of complications. Conclusions: Through this article, we would like to enhance the importance of thought-provoking new techniques in tackling complex challenging referrals.

Magnetic resonance imaging brain findings in a case of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder, presenting with intractable vomiting and hiccups.

Neuromyelitisoptica (NMO) and multiple sclerosis (MS) were once considered to be differing manifestation of same auto immune disease, NMO predominantly involving the optic nerve and cord. Now with discovery of NMO antibody the concept has changed and a spectrum of disorders with lesions in brain has been identified. Occasionally, brain may be the first or the only site of involvement in these disorders hence it is essential to be aware of this spectrum. The brain lesions in NMO/NMOSD may be located in characteristic regions and present with symptoms mimicking non neurological disease. We herein present a case of an adult female who was admitted with intractable vomiting and hiccups; subsequently on MRI brain found to have very tiny demyelinating foci in Area Postrema.