ARTIFICIAL WIDENING OF THE MEDIASTINUM TO GAIN ACCESS FOR EXTRAPLEURAL BIOPSY - CLINICAL-RESULTS

PURPOSE: To assess the utility of artificial widening of the extrapleu ral space to gain an extrapleural biopsy access route to the anterior and posterior mediastinum. MATERIALS AND METHODS: The authors retrospe ctively analyzed the findings in 20 patients who underwent biopsy of m ediastinal masses after dilation of the extrapleural space with inject ion of approximately 20 mt of physiologic saline solution. The solutio n was injected to provide ventral (n = 6) or dorsal (n = 14) extrapleu ral 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 who m a dorsal approach was used. The paravertebral extrapleural soft tiss ue 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 fo ur 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 o f 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 w idening of the extrapleural space provides an access route to the ante rior and posterior mediastinum for large-bore biopsy.