PROCEDURE: Ultrasound guided percutaneous liver biopsy       

INDICATION: Status post Orthotopic liver transplantation (OLT) with elevated transaminases.

DATE:     

OPERATOR: 

MEDICATIONS: Versed     mg IV, fentanyl     mg IV, Zosyn 3.375 gm IV

DEVICE: 18g core biopsy device through 17g coaxial needle guide

SPECIMENS: Two 18-gauge core biopsy specimens

COMPLICATIONS: None immediate

 

TECHNIQUE: The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained.

The right flank and upper abdomen were prepped and draped in sterile fashion.  Ultrasonographic evaluation of the liver was carried out. Using local anesthetic, under direct ultrasound guidance and with images transferred to PACS, a 17 gauge needle guide was advanced into the liver. Two coaxial passes were made through the guide with an 18 gauge biopsy gun. The specimens were placed in formalin. The tract was embolized with Gelfoam pledgets and a sterile dressing was applied.

The procedure was well-tolerated, and the patient was discharged from the procedure suite in satisfactory condition.

 

FINDINGS:

  1. Ultrasound evaluation shows no evidence for intrahepatic biliary ductal dilatation.
  2. Ultrasound documentation of introducer needle tip position confirmed and stored to PACS.
  3. Two 18 gauge hepatic cores appeared adequate.

 

IMPRESSION:

Ultrasound guided liver biopsy as described.