Minimally Invasive Interventional Radiology

Brattleboro Memorial Hospital Radiology Offers Minimally Invasive Services to patients requiring biopsy, drainage and other procedures. All Radiologists are board certified by the American College of Radiology.

Patients requiring these services are referred by their provider.

Thyroid Biopsy

During a fine needle aspiration biopsy of the thyroid, a small sample of tissue is removed from the thyroid gland. The thyroid gland is located in front of the neck just above the neckline and is shaped like a butterfly, with two lobes on either side of the neck connected by a narrow band of tissue.

Nodules or abnormalities in the body are often detected by imaging examinations. However, it is not always possible to tell from these imaging tests whether a nodule is benign (non-cancerous) or cancerous.

A needle biopsy, also called a needle aspiration, involves removing some cells—in a less invasive procedure involving a hollow needle—from a suspicious area within the body and examining them under a microscope to determine a diagnosis.
What are some common uses of the procedure?

  • Thyroid biopsy is used to find the cause of a nodule in the thyroid gland.
  • When a nodule is detected, imaging tests may be performed to help determine if it is benign (non-cancerous) or malignant (cancerous). If imaging studies cannot clearly define the abnormality, a biopsy may be necessary.

What is Needle Biopsy of Lung (Chest) Nodules?

  • A lung nodule is relatively round lesion, or area of abnormal tissue located within the lung. Lung nodules are most often detected on a chest x-ray and do not typically cause pain or other symptoms.
  • Nodules or abnormalities in the body are often detected by imaging examinations. However, it is not always possible to tell from these imaging tests whether a nodule is benign (non-cancerous) or cancerous.
  • A needle biopsy, also called a needle aspiration, involves removing some cells—in a less invasive procedure involving a hollow needle—from a suspicious area within the body and examining them under a microscope to determine a diagnosis.
  • In a needle biopsy of lung nodules, imaging techniques such as computed tomography (CT) and fluoroscopy are often used to help guide the interventional radiologist’s instruments to the site of the abnormal growth.

What are some common uses of the procedure?

Although more than half of single (called solitary) nodules within the chest are determined to be benign, these lesions are considered potentially malignant until proven otherwise, usually through a needle biopsy.

When a nodule is detected, imaging tests may be performed to help determine if it is benign (non-cancerous) or malignant (cancerous). If imaging studies cannot clearly define the abnormality, a biopsy may be necessary.

PERCUTANEOUS ABSCESS DRAINAGE:

An abscess is an infected fluid collection within the body. In general, people who have an abscess will experience fever, chills and pain in the approximate location of the area that is involved. If a patient has these symptoms, it is not uncommon that they will undergo an imaging test, (usually a CT scan or an ultrasound), to assist in identifying and making the correct diagnosis of an abscess. Once the diagnosis of an abscess has been made, your physician and an interventional radiologist will work together to decide the appropriate therapy. As long as it is deemed safe, percutaneous abscess drainage offers a minimally invasive therapy that can be used to treat the abscess.

In percutaneous abscess drainage, an interventional radiologist uses imaging guidance (CT, ultrasound or fluoroscopy) to place a thin needle into the abscess to remove or drain the infected fluid from an area of the body such as the chest, abdomen or pelvis. Usually, a small drainage tube is left in place to drain the abscess fluid. Occasionally, abscesses that cannot be treated by percutaneous drainage may require surgical drainage in the operating room.
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What are some common uses of the procedure?

Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. The abscess may be the result of recent surgery or secondary to an infection such as appendicitis. Less commonly, percutaneous abscess drainage may be used in the chest or elsewhere in the body.

LUMBAR PUNCTURE

Lumbar puncture (also called a spinal tap) is a minimally invasive, image-guided diagnostic test that involves the removal of a small amount of cerebrospinal fluid—the fluid that surrounds the brain and spinal cord—or an injection of medication or other substance into the lumbar (or lower) region of the spinal column.

Cerebrospinal fluid is a clear, colorless liquid that delivers nutrients to and cushions the brain and spinal cord.

What are some common uses of the procedure?

A lumbar puncture is typically performed to:

  • collect a sample of cerebrospinal fluid to be analyzed in a laboratory
  • measure the pressure of fluid in the spinal canal
  • remove some cerebrospinal fluid to decrease pressure in the spinal canal
  • inject chemotherapy drugs or other medications into the cerebrospinal fluid.

The lumbar puncture procedure helps physicians diagnose:

  • bacterial, fungal and viral infections, including meningitis, encephalitis and syphilis
  • bleeding around the brain (subarachnoid hemorrhage)
  • cancers involving the brain and spinal cord
  • inflammatory conditions of the nervous system, including Guillain-Barre syndrome and multiple sclerosis

EPIDURAL INJECTION

An epidural injection is delivered into the epidural space of the spine to provide temporary or prolonged relief from pain or inflammation. The epidural space is located outside the dural membrane. Steroids, anesthetics and anti-inflammatory medications are typically delivered in an epidural injection. The injection may reduce pain and swelling in and around the spinal nerve roots, as well as around damaged nerves which in time may heal.

Imaging guidance, such as fluoroscopy or computed tomography (CT or “CAT” scan), may be used to help the doctor place the needle in exactly the right location so the patient can receive maximum benefit from the injection.

What are some common uses of the procedure?

An epidural injection is one of many methods doctors use to relieve pain, along with physical therapy, oral medications and surgery if a patient is not responding to conservative treatments.

An epidural injection may be performed to alleviate pain caused by:

  • A herniated or bulging disk
  • Spinal stenosis
  • Post-operative “failed back” surgery syndromes (chronic back or leg pain after spinal surgery)
  • Other injuries to spinal nerves, vertebrae and surrounding tissues

Chest Interventions

What are Chest Interventions?

  • Chest interventions are minimally invasive procedures used to diagnose and treat pleural effusions, a condition in which there is excess fluid in the pleural space, also called the pleural cavity. This space exists between the outside of the lungs and the inside of the chest wall.
  • A pleural effusion is caused by several conditions including infection, inflammation, heart failure or cancer. Excess fluid in the pleural space can make it difficult to breathe.

Chest interventions include:

  • thoracentesis, in which excess fluid in the pleural space is removed by a needle attached to a syringe and a sample of the fluid is analyzed under a microscope.
  • pleurodesis, in which a medication is injected into the pleural space to shrink the cavity and minimize the amount of fluid that can collect there.
  • pleural biopsy, in which tissue samples are removed from the pleural membrane, the layer of tissue that lines the pleural cavity, with a hollow needle and analyzed under a microscope.

What are some common uses of the procedure?

Thoracentesis is performed to:

  • relieve pressure on the lungs
  • treat symptoms such as shortness of breath and pain
  • determine the cause of excess fluid in the pleural space.

Pleurodesis is performed to prevent the collection of pleural fluid following thoracentesis.

A pleural biopsy is performed when the cause for excess fluid in the pleural space cannot be determined by thoracentesis. The tissue sample removed from the pleural membrane during a biopsy is further analyzed for evidence of:

  • tuberculosis
  • cancer cells
  • the presence of viral, fungal or parasitic disease.

What is a Peritoneal Port?

A peritoneal port is a small reservoir or chamber that is surgically implanted under the skin to provide a painless way of withdrawing excess fluid from or delivering anti-cancer drugs into the abdominal or peritoneal cavity over a period of weeks, months or even years. The port has a silicone rubber top that can be penetrated by a needle and an attached catheter that is designed to hang down into the abdominal cavity once it is placed inside the body.

The peritoneal port is implanted during a minimally invasive procedure so that patients may undergo treatments such as:

  • serial paracentesis, in which excess fluids in the abdomen are repeatedly withdrawn through a catheter connected to the port.
  • intraperitoneal therapy, in which anti-cancer drugs are delivered into the peritoneal cavity through a catheter connected to the port.

What are some common uses of the procedure?

Physicians use peritoneal ports to help treat:

  • intractable ascites, a condition in which excess fluid continually builds up in the abdominal, or peritoneal cavity. Ascites may be caused by cirrhosis (chronic liver disease), cancer, heart failure, kidney failure, tuberculosis or pancreatic disease.
  • ovarian cancer.

Reference: Radiologyinfo.org for further information