CT-guided transthoracic needle biopsy using an ipsilateral dependent position.

OBJECTIVE: We postulated that the pneumothorax rate of transthoracic needle biopsy might improve with an ipsilateral dependent position of the affected side. We tried to determine the feasibility, effectiveness, and safety of CT-guided biopsy with the patient in this position. SUBJECTS AND METHODS: CT-guided needle biopsy with the patient in an ipsilateral dependent position was performed in 23 patients with 17 lung lesions (15 posterior and two anterior) and six mediastinal lesions. Fine-needle aspiration was used in all patients, and core biopsy was also used in six patients. The technical difficulty of the procedure was classified into three grades compared with a routine transthoracic needle biopsy as follows: grade I, no more difficult; grade II, somewhat more difficult; and grade III, much more difficult. RESULTS: Adequate samples were obtained in 22 (96%) of 23 patients. A small asymptomatic pneumothorax occurred in two patients (8.7%). Difficulty was rated grades I, II, and III in 18 (78%), two (9%), and three (13%) procedures, respectively. Four of the five grades II and III procedures were biopsies of anterior lesions. Traversing the pleura was avoided in three of six mediastinal masses. CONCLUSION: Transthoracic needle biopsy of selected lung and mediastinal lesions using an ipsilateral dependent position is feasible, effective, and safe. The role of this technique for reducing the rate of pneumothorax as a result of the biopsy requires further investigation.

Balloon angioplasty or stent placement in patients with azotemic renovascular disease: a retrospective comparison of clinical outcomes.

In this study comparing functional outcomes of renal angioplasty alone (PTRA) or angioplasty with stent placement in patients with renal artery stenosis (> or =60%) and renal insufficiency, 69 patients were treated with PTRA or stent placement. After censoring, the PTRA group included 15 patients with a mean age of 75 years, mean serum creatinine (Cr) of 2.9 +/- 1.4 mg/dL, and mean follow-up of 10 months. The stent placement group included 40 patients with a mean age of 71 years, mean Cr of 2.6 +/- 1.2 mg/dL, and mean follow-up of 12 months. Stenting was performed primarily in four cases and after suboptimal angioplasty in the remainder. Benefit was defined as either stabilization (+/-20%) or improvement in serum Cr levels. Technical success was achieved in 16 of 17 (94%) PTRA patients and 55 of 58 (95%) patients receiving stents. Complications included one surgically repaired axillary pseudoaneurysm, one distal stent positioning requiring a second stent, one stent protruding 5 mm into the aorta, two dissections requiring additional stents, one retroperitoneal hematoma, and one intrarenal atheroembolism treated with thrombolysis. Three patients (mean initial Cr 3.9 mg/dL) required hemodialysis within 30 days of stenting. One patient discontinued dialysis after stenting. There were two procedure-related deaths. An overall benefit was seen in 40% of patients after PTRA and 66% of patients after stent placement. For the stent placement and PTRA groups, cumulative clinical benefit was 77% and 80%, respectively, at 3 months; 69% and 64%, respectively, at 6 months; 61% and 41%, respectively, at 12 months; and 48% and 14%, respectively, at 24 months. A 50% loss of cumulative benefit was seen 34 months after stenting and 11.5 months after PTRA. In the stent and PTRA groups, benefit was noted in 77% and 57%, respectively, of patients with an initial Cr of 2.3 or less, 53% and 25%, respectively, of patients with an initial Cr level higher than 2.3, and 44% and 17%, respectively, of patients with an initial Cr level of 3.0 mg/dL or more. For patients with renal insufficiency, renal artery stenting provides superior clinical results compared with PTRA, mostly because late deterioration occurs after PTRA. Outcomes are related to pretreatment serum Cr level.