Abstract

Introduction: The current article presents a clinical case of ultrasound controlled transthoracic tru-cut needle biopsy of a small metastatic lesion in the left lung, performed with contrast-enhanced ultrasonography (CEUS). The following case demonstrates a real-time interventional manipulation of a very small lesion, which was done under local anesthesia, with a minimal invasion to the patient.

Case Presentation: A 72-year-old woman is presented, hospitalized for a left-sided pleural effusion with bilateral, multiple nodulеs of different sizes in the lungs. Thoracentesis revealed data for atypical cells in the pleural fluid. The CT scan suspected a probable neoplastic process, but the subsequently performed fiberbronchoscopy couldn’t prove the existence of the same. The final diagnosis was established after ultrasound controlled transthoracic tru-cut needle biopsy of a pulmonary lesion with the application of a contrast medium.

Conclusion: The CEUS allows precise detection of the metastatic area because of its unique perfusion characteristics and ability to remain hypocontrasted after the application of the contrast medium sulfur hexafluoride. The persistence of a concomitant left-sided pleural effusion is used as an ultrasound window during the performance of the manipulation, with the successful verification of the pathology as primary pulmonary adenocarcinoma. By the application of this minimally invasive manipulation, an accurate final histological result was obtained.

Keywords: CEUS, Metastatic lesion, Tru-cut needle biopsy, Pleural effusion, CT scan, Pulmonary adenocarcinoma.