Radiology, Vol 196, 703-706, Copyright © 1995 by Radiological Society of North America
Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results
HJ Langen, KC Klose, P Keulers, G Adam, M Jochims and RW Gunther
Department of Diagnostic Radiology, Technical University of Aachen, Germany.
PURPOSE: To assess the utility of artificial widening of the extrapleural
space to gain an extrapleural biopsy access route to the anterior and
posterior mediastinum. MATERIALS AND METHODS: The authors retrospectively
analyzed the findings in 20 patients who underwent biopsy of mediastinal
masses after dilation of the extrapleural space with injection of
approximately 20 mL of physiologic saline solution. The solution was
injected to provide ventral (n = 6) or dorsal (n = 14) extrapleural access
to the mediastinum. Biopsies were performed under computed tomographic
guidance. RESULTS: Right-sided paravertebral extrapleural access to the
mediastinum was achieved in 11 of the 14 patients in whom a dorsal approach
was used. The paravertebral extrapleural soft tissue was dilated from a
mean of 0.2 cm to a mean of 0.9 cm. Extrapleural biopsy was performed in
nine patients. The pleura was traversed in four patients, causing
pneumothoraces in two. A parasternal access route was created in all six
patients in whom a ventral approach was used, and biopsies were performed
without complications. The minimal width of the anterior mediastinum in
these six patients increased from a mean of 2.8 cm to a mean of 4.6 cm with
dilation. CONCLUSION: Artificial widening of the extrapleural space
provides an access route to the anterior and posterior mediastinum for
large-bore biopsy.
