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Detection and management of bleeding in the setting of image-guided percutaneous needle biopsy

  • Special Section: Cross sectional interventions
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Abstract

Image-guided percutaneous needle biopsy (PNB) is an important and increasingly utilized method of minimally invasive tissue sampling for a broad variety of disease processes. While infrequent, major bleeding is a potential complication of PNB and can be life-threatening, especially when unrecognized. On the other hand, prompt recognition and treatment of major bleeding in this setting can prevent significant morbidity or mortality. It is therefore crucial for anyone performing PNB to be familiar with the diagnosis and management of bleeding complications. This article reviews the risk factors for major bleeding in the setting of PNB, the presentation and imaging findings of a spectrum of bleeding complications encountered during and following PNB, and the management of those findings based on experience at a single, high volume, biopsy center.

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Fig. 1 Displacement of needle from target by rapidly developing hematoma
Fig. 2 Spectrum of perinephric hematomas following native renal biopsy
Fig. 3 Limited extravasation managed with close observation
Fig. 4 Right shoulder pain after liver biopsy
Fig. 5 Diffuse cortical hemorrhage and ruptured subcapsular hematoma following native renal biopsy
Fig. 6 Active hemorrhage not detected by post-biopsy US
Fig. 7 Degradation of biopsy target visibility on US by hemorrhage
Fig. 8 Resolution of flow within patent biopsy tract after manual pressure
Fig. 9 Patent biopsy tract communicating with expanding hematoma
Fig. 10 Post-biopsy renal arteriovenous fistula
Fig.11 Delayed bleeding from ruptured post-biopsy renal transplant pseudoaneurysm 
Fig. 12 Post-biopsy contrast-enhanced ultrasound
Fig. 13 Percutaneous gelatin foam slurry embolization
Fig. 14 Percutaneous gelatin foam pledget embolization 
Fig. 15 Gelatin foam pledget preparation
Fig. 16 Percutaneous thrombin injection 

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  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA

    Benjamin S. Strnad, Malak Itani & William D. Middleton

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Strnad, B.S., Itani, M. & Middleton, W.D. Detection and management of bleeding in the setting of image-guided percutaneous needle biopsy. Abdom Radiol 47, 2681–2696 (2022). https://doi.org/10.1007/s00261-021-03357-5

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  • DOI: https://doi.org/10.1007/s00261-021-03357-5

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