CT-guided large-bore biopsy: extrapleural injection of saline for safe transpleural access to pulmonary lesions

A new technique was applied to improve safety for large-bore biopsies of subpleural pulmonary lesions. In 27 patients, normal saline solution (20-40 ml) was injected extrapleurally under CT-guidance in the access route to subpleurally situated lung lesions. Thickness of ventilated lung interposed between the target and the parietal pleural was up to 8 mm (mean: 4.1 mm). The injected fluid resulted in an extrapleural bulge that abutted the lesion to be biopsied. Biopsy with the 14-gauge Trucut needle did not result in pneumothorax in all cases. There were no complications associated with this technique. Extrapleural injection of saline may provide a safe access route to selected pulmonary lesions for CT-guided large-bore transthoracic biopsies.