Splenic Biopsy Aspiration Drainage Mar/april 2012

Front 1

How successful is splenic intervention ?

Back 1

splenic biopsy is successful in 91% ,
splenic fluid aspiration in 100%,
and splenic fluid drainage in 86%

Front 2

pre op

Back 2

(a) a minimum platelet count of at least 50,000/μL; (b) an
acceptable international normalized ratio of less
than 1.2; and (c) an acceptable activated partial
thromboplastin time of 20–33 seconds.
In adult patients, conscious sedation is produced by using midazolam (Versed; Roche Laboratories, Nutley, NJ) and fentanyl citrate (ElkinsSinn, Cherry Hill, NJ). After the procedure, all
outpatients are monitored; blood pressure and
pulse rate are measured every 15 minutes for the
1st hour, every 30 minutes for the next 2 hours,
and then every 3 hours. Typically, patients are
kept in the hospital for 3 hours after biopsy and
24 hours after catheter drainage to monitor for

Front 3

reason for doing procedure

Back 3

The primary indication for splenic biopsy is an
indeterminate solid or cystic lesion for which a
combination of clinical, radiologic, and blood
culture findings has failed to allow diagnosis

Front 4

Hemostasis

Back 4

At the end of the procedure, we
often inject hemostatic gelatin sponge to achieve
hemostasis along the needle track

Front 5

technique

Back 5

Pleural puncture can be
avoided during biopsy of splenic lesions located
near the dome of the diaphragm by using realtime US guidance (Fig 5) or the gantry tilt CT
technique, 22 degree

Front 6

splenic procedural complication

Back 6

Front 7

pneumothorax complication

Back 7

Although the transpulmonary approach can be used for biopsy of hepatic
or splenic lesions near the dome of the diaphragm, it is associated with an approximately 15% risk of pneumothorax.

Front 8

other complications

Back 8

In cases of progressively expanding
hematomas not responding to fluid resuscitation
and transfusion, the treatment options include
transcatheter embolization and splenectomy.
Other less common complications include pneumothorax, pleural effusion, and colonic injury

Front 9

advantage of drainage over surgery

Back 9

Image-guided treatment is less invasive
than surgical treatment and has the advantage of
avoiding long-term immunologic dysfunctions
related to splenectomy

Front 10

drainage complication

Back 10

Lucey et al (1)
and Taşar et al (14), one of seven and one of
nine patients who underwent catheter drainage,
respectively, experienced significant hemorrhage
that led to splenectomy. This is why patients
should be admitted to the hospital after the
procedure and closely monitored for possible
complications.

Front 11

alcohol treatment of cyst

Back 11

alcohol ablation has been
most extensively used for treatment of liver and
renal cysts, it has also been used for treatment
of pancreatic cysts, splenic cysts, thyroid cysts,
bronchogenic cysts, lymphoceles, lymphangiomas, and spermatoceles.

Front 12

splenic cyst treatment with ETOH

Back 12

The procedure is typically performed with conscious sedation produced
by means of intravenous midazolam and fentanyl.
With US guidance, an 8–10-F pigtail catheter is
inserted by using the trocar technique and all fluid
is aspirated (Fig 13). The fluid is sent for Gram
staining, culture, and cytologic analysis.

Front 13

splenic drainage procedure

Back 13

A small amount of diluted contrast material
can be injected through the catheter to ensure
optimal placement of the catheter and rule out
leakage of fluid into the peritoneal cavity. Approximately 50% of the aspirated fluid volume is
replaced with 95% ethyl alcohol (maximum, 100
mL) and removed after 20 minutes

Front 14

post procedure follow up splenic cyst ETOH treatment

Back 14

Complications of alcohol ablation include hypotension, pain, bleeding, infection, and chemical
damage to adjacent organs. Follow-up CT is performed 3 months later to evaluate for recurrence
of the treated cyst and to plan any additional
interventions, if needed.

Front 15

splenic pseudoanuerysm treatment with thrombin

Back 15

Another technique for treatment of
pseudoaneurysms is percutaneous occlusion with
image-guided thrombin injection. This approach
has been most extensively used for management of femoral artery pseudoaneurysms (28).
This method has also been used to treat pseudoaneurysms secondary to pancreatitis (29,30).
Robinson et al (31) described use of endoscopic
US-guided thrombin injection for treatment of a
splenic artery pseudoaneurysm.