Demonstration of the course of the posterior intercostal artery (pia) at CT angiography (cta): relevance to interventional radiology (ir) procedures in the chest.

Dewhurst, Catherine; O’Neill, Siobhán; O’Regan, Kevin; Maher, Michael

doi:10.4261/1305-3825.dir.4366-11.1

Cited by 20 publications

(30 citation statements)

References 15 publications

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“…Although minor complications commonly occur during CT‐guided percutaneous needle biopsy, the major complication rate is as low as 5%, composed of pneumothorax requiring intervention, hemothorax, air embolism, needle tract seeding, and death . The rate of hemothorax is only < 0.1% and is partly the result of intercostal artery injury, which is accompanied by high rates of morbidity and mortality . However, this complication might be further avoided with some additional consideration.…”

Section: Discussionmentioning

confidence: 99%

“…The vascular structures with the potential to be injured during transthoracic biopsy mainly include the central large vessels and some systemic arteries: subclavian, axillary, internal mammary, and intercostal . Among these, the intercostal artery requires CT angiography to better demonstrate injury . Traditionally, when interventionalists try to avoid intercostal artery injury during transthoracic puncture, it is based on anatomical knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…The biopsy was taken from the left lower back, 11 cm from the spine; however, the intercostal artery at the puncture region in this case was still injured, even with a 2 mm gap below the inferior rib margin, suggesting that the intercostal artery at this region in this case was not located in the subcostal groove. The intercostal artery might be exposed within the intercostal space in the first 6 cm from the spine, with even wider variation in older patients and in cephalad rib spaces . Considering the possible wide variation in the intercostal artery course, we propose two key points for procedural planning: (i) if possible, choose a target lesion in the anterior rather than the posterior lung because anterior chest wall puncture is safer as the intercostal artery might travel a long course in the back below the subcostal groove; and (ii) if posterior puncture is required, plan a puncture course as close to the superior margin of the ribs as possible, which may require three‐dimensional imaging reconstruction to view a different direction, such as the sagittal view.…”

Section: Discussionmentioning

confidence: 99%

“…The intercostal artery is usually located in the subcostal groove, but with variation. Previous studies have shown that this artery might be exposed below the subcostal groove in the first 6 cm from the spine and varies more widely in older patients and cephalad rib spaces . Therefore, intercostal artery injury is still possible during the transthoracic puncture, even with a gap from the inferior rib margin.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that this artery might be exposed below the subcostal groove in the first 6 cm from the spine and varies more widely in older patients and cephalad rib spaces. 8,9 Therefore, intercostal artery injury is still possible during the transthoracic puncture, even with a gap from the inferior rib margin. Herein, we demonstrate a case in which a disastrous complication of CT-guided lung tumor biopsy occurred.…”

Section: Introductionmentioning

confidence: 99%

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Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

et al. 2018

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Intercostal artery injury during transthoracic puncture is rare but is accompanied by high rates of morbidity and mortality. We report a case with metachronous double primary esophageal cancers and development of multiple lung nodules. Tissue proof for the lung nodules is required to guide the following treatment protocol. Our patient died soon after computed tomography‐guided lung tumor biopsy was performed, as a result of procedure‐related massive and uncontrolled hemothorax. The cause is likely intercostal artery injury related to the transthoracic puncture. After review of our case and the wide variation in intercostal artery courses, we identify several considerations that should be included in procedural planning to further decrease the risk of intercostal artery injury during transthoracic puncture, including avoiding choosing target lesions at the posterior lung, keeping the puncture needle as close to the superior rib margin as possible, and checking the density of new pleural fluid. In addition, it is important to inform clinical doctors when the risk of periprocedural vascular injury is high.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

et al. 2018

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Can we predict the existence of extrarenal feeders to renal angiomyolipomas?

et al. 2018

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To identify factors predicting the presence of extrarenal feeders to renal angiomyolipomas (AMLs). MethodsThis is a retrospective study of 44 patients with 58 renal AMLs embolized in our department. Arteriography obtained during embolization and CTA obtained before and after embolization were reviewed to characterize AMLs with and without extrarenal feeders. Tumor characteristics were compared between the two groups.Simple logistic regression and ROC curve analysis were performed. P < 0.05 was considered to be statistically significant. ResultsOf the 58 AMLs reviewed, 29% had extrarenal arteries and 71% did not. AMLs with extrarenal feeders were significantly larger than those without, in terms of volume (median, 368 mL versus 109 mL, p < 0.0002) and largest diameter (mean, 12.0 cm versus 7.7 cm, p < 0.0001). Patient age, presence of tuberous sclerosis complex or sporadic lymphangioleiomyomatosis, and tumor location did not differ between the groups. Largest diameter and volume had similar predictive values for the presence of extrarenal feeders (AUC, 0.83 versus 0.82, p = 0.673). Extrarenal feeders were present in 0%, 21%, and 79% of the AMLs ≤6.5 cm, AMLs 6.6-10.5 cm, and AMLs >10.5 cm, respectively. ConclusionsAML size correlates with the presence of extrarenal feeders, with largest diameter and volume being significant predictors. AMLs >10.5 cm had a high chance of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤6.5 cm did not have extrarenal feeders, making a search for them unnecessary in these cases.

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Risk of Procedural Hemorrhage

Wolfe

Kress

2016

Chest

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Patients who are critically ill and hospitalized often require invasive procedures as a part of their medical care. Each procedure carries a unique set of risks and associated complications, but common to all of them is the risk of hemorrhage. Central venous catheterization, arterial catheterization, paracentesis, thoracentesis, tube thoracostomy, and lumbar puncture constitute a majority of the procedures performed in patients who are hospitalized. In this article, the authors will discuss the risk factors for bleeding complications from each of these procedures and methods to minimize risk. Physicians often correct coagulopathy prior to procedures to decrease bleeding risk, but there is minimal evidence to support this practice.

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Demonstration of the course of the posterior intercostal artery (pia) at CT angiography (cta): relevance to interventional radiology (ir) procedures in the chest.

Cited by 20 publications

References 15 publications

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

Can we predict the existence of extrarenal feeders to renal angiomyolipomas?

Risk of Procedural Hemorrhage

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