Naslov
Artificial pneumothorax - an ally in interventional oncology

Autori
Krešić, Elvira ; Prutki, Maja ; Čavka, Mislav ; Kuhtić, Ivana ; Marušić, Ante ; Alduk, Ana Marija

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Electronic Presentation Online System (EPOS) - European Congress of Radiology 2020 / - Beč : Europsko radiološko društvo, 2020

Skup
European Congress of Radiology - ECR2020: A Clear Vision for Radiology

Mjesto i datum
Online; konferencija, 15.07.2020. - 19.07.2020

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
metastases ; cancer ; biopsy ; ablation procedures ; percutaneous ; fluoroscopy ; CT ; thorax ; interventional non-vascular ; interventional radiology

Sažetak
Learning objectives 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. Background Hepatic dome is a challenging location for percutaneous interventions. 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 interventions. 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 as the blunt- tip portion of the Veress needle springs forward into the pleural cavity. A small amount of air (3- 5 mL) is then injected and the correct position of the needle tip in pleural space is confirmed with CT. Air is then injected with a 50 mL syringe to separate the lung from the pleura. Usually, 150- 300 mL of air is required to create a safe pathway to hepatic dome lesions which is confirmed with CT.The Veress needle is left in place during the procedure - thermal ablation or biopsy. Following the procedure, the Veress needle is used in combination with stopcock to aspirate and expel the intrapleural air until complete resolution. A follow-up chest radiograph should be done two hours after the procedure to assess potential recurrence of pneumothorax. 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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA