Biopsies

General Principles

Pre-Procedural

• Review of the case and choosing the right lesion to biopsy
  • To biopsy or not to biopsy - 3 case scenarios on reviewing cases in detail before planning the biopsy
• Coagulation check and tranexamic acid prophylaxis
  • Case 112: 63-years old - pancreatic head biopsy with hemorrhage
• Consent
  • A video on how I take consent

Procedural

• FNAC vs Biopsy
  • Case 67: 66-years old - 23 mm nodule right middle lobe - left lateral decubitus - discussion on FNAC vs biopsy - tuberculosis
• Machine
• Tray
• Guns
• Sedation and Anesthesia
  • General / Conscious
  • Local - pleural, diaphragmatic, traversing nerves
• Sampling (how much and for what)
  • Case 68: 26-years old - L3 body lesion - transpedicular approach and perivertebral soft tissue - how to maximize obtaining adequate material - tuberculosis
  • Case 85: 66-years old - L4/5 discitis - posterolateral perivertebral approach - post-operative spine - don't forget fungal - Candida fungal infection
  • Case 86: 26-years old - L5/S1 infectious spondylitis - S1 ala biopsy - don't forget fungal (geography matters) - Coccidiodes immitis infection
• Bone and Soft Tissue Mass Biopsy Rules
  • Case 66: 60-years old - distal femur lesion - clear cell chondrosarcoma
  • Case 129: 31-years old - proximal humerus and adjacent soft tissue mass - mesenchymal chondrosarcoma - literature review and my take on how to increase diagnostic yield
• Diagnosis on Table
  • Case 49: 75-years old - L4 body lesion - transpedicular approach - black tissue cores - melanoma metastasis
  • Case 50: 34-years old - pretracheal and paratracheal mass - extrapleural approach with hydrodissection - rock hard to feel - mediastinal fibrosis
  • Case 51: 32-years old - apical posterior mediastinal mass - electric shock on touching - schwannoma
  • Case 57: 40-years old - left adrenal nodule - posterior approach - skin lesions of Addison's disease - histoplasmosis
• Tips and Tricks
  • Gantry Angulation
    • Case 81: 60-years old - 20.22 mm left apical nodule - gantry angulation - organizing pneumonia
    • Case 83: 51-years old - 9.7 mm left upper lobe lung nodule - gantry angulation to avoid vessels - organizing pneumonia
  • Patient Positioning
    • Flexion/Extension
      • Case 72: 31-years old - C1 lateral mass - posterior approach - flexion to avoid vertebral artery - tuberculosis
    • Changing Positions
      • Case 76: 57-years old - 15.2 mm right upper lobe lung nodule - multiple positioning attempts - supine oblique - needle breathed out - metastasis
    • Decubitus (see lung nodules)
  • Needle Angulation
  • Understanding the Importance of Stylet Length During Needle Placement
    • Case 99: 69-years old - lung mass - improper understanding of needle length led to poor placement of the canula and a pneumothorax, which was aspirated
  • Flipping / Multidirectional / Multiquadrant biopsy
    • Case 93: 86-years old - multidirectional rotation of the biopsy gun for better sampling
  • Railroading
    • Case 94: 47-years old - iliopubic ramus biopsy - lesion small for length of throw
  • Correcting Breathed Out Needles
    • Case 76: 57-years old - 15.2 mm right upper lobe lung nodule - multiple positioning attempts - supine oblique - needle breathed out - metastasis
  • Transorgan
    • Transosseous
      • Case 36: 36-years old - prevascular space masss - transsternal approach - germ cell tumor - seminoma
      • Case 37: 53-years old - prevascular space mass - transsternal transpulmonary approach - thymoma
      • Case 38: 76-years old - pretracheal space mass - transsternal approach - adenocarcinoma
      • Case 39: 23-years old - loculated pleural collection - transscapular approach - tuberculosis
      • Case 62: 60-years old - right common iliac node - transsacral approach - metastasis
      • Case 84: 20-years old - sacroilitis - prone approach - transosseous - transiliac bone - tuberculosis
    • Transpulmonary
      • Case 31: 36-years old - 20 mm subcarinal node - transpulmonary approach - tuberculosis
      • Case 37: 53-years old - prevascular space mass - transsternal transpulmonary approach - thymoma
    • Transpleural (pneumothorax, effusion, collection)
      • Case 32: 55-years old - 26.4 mm subcarinal node - transpleural approach - pre-existing pneumothorax - sarcoidosis
      • Case 139: 38-years old - chest wall lesion involving ribs - transpleural collection approach - metastasis from Ca tongue
    • Transhepatic
      • Case 138: 23-years old - necrotic portal nodes using a transhepatic approach - tuberculosis
    • Transbowel
      • Case 79: 57-years old - pancreatic head mass - transcolonic approach - adenocarcinoma
      • Case 80: 64-years old - mesenteric mass - transcolonic approach - metastasis
    • Transiliopsoas
      • Case 88: 60-years old - right iliac bifurcation node - transiliopsoas approach - metastasis
    • Transthyroid
      • Case 92: 58-years old - cervical esophageal mass biopsy - transthyroid approach - squamous cell carcinoma
  • Displacing Structures (Bowel, Organs, etc)
    • Case 82: 66-years old - pancreatic head mass - displacing bowel - adenocarcinoma
  • Fixed Point Method
    • Case 70: 48-years old - pancreatic body mass - fixed point method - adenocarcinoma
    • Case 71: 54-years old - perivascular recurrent mass - fixed point method - adenocarcinoma
    • Case 104: 61-years old with a 15.2 mm retrocaval retroperitoneal node - metastasis
  • Blind Biopsies - Using Measurements and Feel
    • Case 102 - 42-years old - isodense small liver lesion not seen on USG - biopsy using measurements and feel - metastasis from carcinoma breast
  • Curved Needle Technique
    • Case 90: Bending the Needle - 58-years old with an 18.4 mm left adrenal nodule - metastasis
    • Case 104: Bending the Needle - 61-years old with a 15.2 mm retrocaval retroperitoneal node - metastasis
  • Intraprocedural Contrast (See also Pancreas, Porta, Mediastinum)
    • Case 6: 64-years old - uncinate process & head mass - adenocarcinoma
    • Case 38: 76-years old - pretracheal space mass - transsternal approach - adenocarcinoma
    • Case 42: 38-years old - complex retroperitoneal mass - para-aortic biopy with intravenous contrast - pancreatic adenocarcinoma
  • Hydrodissection
    • Case 1: 12-years old - right paratracheal node biopsy with an extrapleural approach
    • Case 30: 15-years old - 31 mm subcarinal node - extrapleural approach - tuberculosis
    • Case 45: 17-years old - 21.1 mm subcarinal node - extrapleural - tuberculosis
    • Case 77: 54-years old - left para-aortic mass - parasternal approach with hydrodissection (salinoma) - metastasis
• Complications
  • Do No Harm
  • Bleeding
    • Case 8: Respect the lung
    • Case 112: Hemorrhage during a pancreatic head mass biopsy - what to do
  • Pneumothorax (see in lung)
    • Case 8: Respect the lung
    • Case 18: Managing entry pneumothorax
    • Entry and exit pneumothorax - strategies to reduce incidence and manage if the pneumothorax still occurs
    • Case 99: 69-years old - lung mass - pneumothorax, aspirated
    • Case 122: 64-years old - lung adenocarcinoma - rapid rollover to reduce the rate of pneumothorax and chest drain insertion
  • Vasovagal

Post-Procedural

• Managing samples
• Managing patients
  • Case 120: 67-years old ex-smoker with emphysema - 16.7 mm lung nodule - biopsy and RFA - when can he fly back home?
• Follow-up of reports and patients
  • Case 45: 17-years old - 21.1 mm subcarinal node - extrapleural - the need for patience - all initial reports negative - only culture at 6 weeks positive
  • Case 46: 75-years old - D12 vertebral body tuberculosis - costovertebral approach - the need for patience - all initial reports negative - only culture positive at 6 weeks.
  • Case 65 - 22-years old - sacrolitis - prone approach - the value of patience and waiting for the culture report before repeating a biopsy - tuberculosis
• Repeating biopsies
  • Case 64: 49-years old - multifocal osteolytic and osteosclerotic bone lesions - repeat biopsy done from osteolytic and sclerotic foci - three sites - lymphoma
  • Case 69: 30-years old - prevascular space mass - parasternal approach - whose responsibility is it to chase up negative biopsies? - lymphoma

Individual Organs

Chest

• Lung

  • Masses (> 30 mm)
    • Case 99: 69-years old - > 5 cm mass right upper lobe - adenocarcinoma
  • Nodules

    • Solid

      • < 6 mm
        • Case 16: 11-years old - 4.8 mm lower lobe nodule - metastasis
        • Case 142: 55-years old - 4.1 mm lower lobe nodule - metastasis - discussion on sub 5 mm nodule biopsy
      • 6-10 mm
        • Case 2: 51-years old - 7.8 mm left lower lobe nodule using a lateral decutibus approach - metastasis
        • Case 83: 51-years old - 9.7 mm left upper lobe lung nodule - gantry angulation to avoid vessels - organizing pneumonia
      • 10-20 mm
        • Case 17: 62-years old - 15 mm nodule right lower lobe - metastasis
        • Case 34: 34-years old - 18 mm right middle lobe subpleural nodule - left lateral decubitus - metastasis
        • Case 35: 63-years old - 10.4 mm right lower lobe nodule - spearing the nodule - tuberculosis
        • Case 76: 57-years old - 15.2 mm right upper lobe lung nodule - multiple positioning attempts - supine oblique - needle breathed out - metastasis
        • Case 120: 67-years old ex-smoker with emphysema - 16.7 mm right upper lobe lung nodule - adenosquamous carcinoma - discussion on when to fly back
        • Case 127: 55-years old - 15.5 mm cavitated lung nodule - biopsy of superior wall - metastasis from ampulla of Vater carcinoma
      • 20-30 mm
        • Case 15: 75-years old - 24 mm nodule right lower lobe with IPF - prone - squamous cell ca
        • Case 67: 66-years old - 23 mm nodule right middle lobe - left lateral decubitus - tuberculosis
        • Case 81: 60-years old - 20.22 mm left apical nodule - gantry angulation - organizing pneumonia
        • Case 122: 64-years old - 21.9 mm known lung adenocarcinoma for mutation studies and rapid rollover to reduce the rate of pneumothorax and chest drain insertion

    • Subsolid

      • Case 109: 77-years old - 17.4 mm subsolid nodule in posterior segment RUL
  • Consolidation
    • Case 18: 64-years old - right lower lobe consolidation - adenocarcinoma

• Mediastinum

  • Prevascular Space
    • Case 36: 36-years old - prevascular space masss - transsternal approach - germ cell tumor - seminoma
    • Case 37: 53-years old - prevascular space mass - transsternal transpulmonary approach - thymoma
    • Case 69: 30-years old - prevascular space mass - parasternal approach - lymphoma
    • Case 137: 46-years old - prevascular space mass - right costoclavicular approach - lymphoma
    • Case 141: 56-years old - thymoma - thymic tumor biopsies, seeding issues, etc
  • Left Para-aortic and Aortopulmonary Window
    • Case 77: 54-years old - left para-aortic mass - parasternal approach with hydrodissection (salinoma) - metastasis
  • Paratracheal / Pretracheal (Visceral Space)
    • Case 1: 12-years old - right paratracheal node biopsy with an extrapleural approach - tuberculosis
    • Case 38: 76-years old - pretracheal space mass - transsternal approach - adenocarcinoma
    • Case 50: 34-years old - pretracheal and paratracheal mass - extrapleural approach with hydrodissection - mediastinal fibrosis
  • Subcarinal
    • Case 30: 15-years old - 31 mm subcarinal node - extrapleural approach with hydrodissection (salinoma) - tuberculosis
    • Case 31: 36-years old - 20 mm subcarinal node - transpulmonary approach - tuberculosis
    • Case 32: 55-years old - 26.4 mm subcarinal node - transpleural approach - pre-existing pneumothorax - sarcoidosis
    • Case 45: 17-years old - 21.1 mm subcarinal node - extrapleural approach with hydrodissection (salinoma) - tuberculosis
  • Posterior Mediastinum (Paravertebral & Others)
    • Case 51: 32-years old - apical paravertebral mass - schwannoma
    • Case 124: 53-years old - left para-aortic posterior mediastinal node - metastastic breast carcinoma
  • Others

• Pleura

  • Case 39: 23-years old - loculated pleural collection - transscapular approach - tuberculosis
  • Case 106: 71-years old - pleural thickening - metastastic adenocarcinoma
  • Case 114: 41-years old - small dry pleural nodule - metastatic thymoma
  • Case 130: 71-years old - small pleural nodule - metastasis from lung adenocarcinoma - parallel approach
  • Case 141: 71-years old - small visceral pleural nodule - metastasis from carcinoma tongue - long parallel approach from the opposite side

Abdomen and Pelvis

• Liver

  • Case 97: 50-years old - multiple liver lesions & pancreatic body lesion - segment 4B liver mass biopsy - metastasis from pancreatic primary
  • Case 102 - 42-years old - isodense liver lesion not seen on USG - measurements and feel - metastasis from carcinoma breast

• Gallbladder

  • Case 100: 46-years old - gallbladder mass infiltrating liver - high grade undifferentiated carcinoma
  • Case 101: 46-years old - gallbladder wall mass with eccentric nodular thickening - small cell carcinoma

• Porta

  • Case 4: 31-years old - necrotic portal node - tuberculosis
  • Case 138: 23-years old - necrotic portal nodes using a transhepatic approach - tuberculosis

• Pancreas

  • Head & Uncinate Process
    • Case 6: 64-years old - uncinate process & head mass - adenocarcinoma
    • Case 79: 57-years old - pancreatic head mass - transcolonic approach - adenocarcinoma
    • Case 82: 66-years old - pancreatic head mass - displacing bowel - adenocarcinoma
    • Case 112: 63-years old - diffuse pancreatic disease - IgG4 disease
  • Body
    • Case 70: 48-years old - pancreatic body mass - fixed point method - adenocarcinoma
    • Case 71: 54-years old - perivascular recurrent mass - fixed point method - adenocarcinoma
  • Tail
    • Case 108: 45-years old - pancreatic tail mass - pseudopapillary solid neoplasm of pancreas

• Spleen

  • Case 115: 73-years old - Ca lung with liver and splenic lesions - tuberculosis abscess of spleen

• Adrenal Glands

  • Case 21: 76-years old - 11.6 mm left adrenal nodule - ipsilateral decubitus - tuberculosis
  • Case 22: 70-years old - 18.8 mm left adrenal nodule - posterolateral approach - metastasis
  • Case 56: 47-years old - 11.3 mm left adrenal nodule - posterior approach - tuberculosis
  • Case 57: 40-years old - 23 mm left adrenal nodule - posterior approach - histoplasmosis
  • Case 90: 58-years old - 18.4 mm left adrenal nodule - posterior approach with bending of the needle for a curve needle approach - metastasis

• Kidneys

  • Case 19: 50-years old - 5.6 cm left renal mass - oncocytoma
  • Case 20: 69-years old - 2.1 cm right renal nodule - renal cell carcinoma

• Ureters

  • Case 118: 78-years old - right mid-ureteric lesion - high-grade urothelial carcinoma
  • Case 119: 63-years old - right pelvi-ureteric junction (PU junction) mass - papillary urotherlial carcinoma

• Bowel

  • Case 91: 72-years old - small bowel mass biopsy - non-Hodgkin's lymphoma
  • Case 92: 58-years old - cervical esophageal mass biopsy - transthyroid approach - squamous cell carcinoma
  • Case 96: 65-years old - cecal surface serosal lesion - metastatic ovarian cancer

• Omentum and Peritoneum

  • Case 5: 69-years old - peritoneal masses - pseudomyxoma peritonei
  • Case 95: 62-years old - omental nodules - metastatic lung cancer
  • Case 96: 65-years old - cecal surface serosal lesion - metastatic ovarian cancer

• Mesentery

  • Case 80: 64-years old - mesenteric mass - transcolonic approach - metastasis

• Retroperitoneum

  • Retrocrural
    • Case 33: 60-years old - retrocrural mass - prone - follicular non-Hodgkin's lymphoma
      Case 111: 68-years old - retrocrural node - prone - metastasis from carcinoma cervix
  • Para-aortic
    • Case 42: 38-years old - complex retroperitoneal mass - prone - para-aortic biopy with intravenous contrast - pancreatic adenocarcinoma
    • Case 43: 64-years old - left para-aortic node from carcinoma sigmoid - first prone, then supine - for mutation studies
    • Case 93: 86-years old - left para-aortic node biopsy - metastasis from endometrial carcinoma - multidirectional rotation of the biopsy gun
  • Aortocaval
    • Case 110: 67-years old with Ca cervix - aortocaval node biopsy, transcolonic, transperitoneal, transmesenteric approach
    • Case 134: 45-years old with Ca cervix - aortocal caval node biopsy - transosseous, transpedicular approach
  • Retrocaval / paracaval / precaval
    • Case 44: 56-years old - large IVC mass - supine - leiomyosarcoma
    • Case 104: 61-years old with a 15.2 mm retrocaval retroperitoneal node using curved needle and fixed point techniques - metastasis
  • Periaortic
    • Case 89: 64-years old - retroperitoneal fibrosis - prone - fibrosis

• Pelvis

  • Ovary
    • Case 47: 64-years old - ovarian mass - serous adenocarcinoma
    • Case 48: 56-years old - ovarian mass - serous adenocarcinoma
  • Uterus
    • Case 126: 68-years old - intra-uterine mass - adenocarcinoma recurrence
  • Nodes
    • Case 62: 60-years old - right common iliac node - transsacral approach - metastasis
    • Case 63: 41-years old - left iliac bifurcation node - anterior transperitoneal approach - necrosis, no viable tumor
    • Case 88: 60-years old - right iliac bifurcation node - transiliopsoas approach - metastasis

Axial Skeleton

• Skull

  • Case 58: 59-years old - left frontal skull bone osteolytic lesion - metastasis
  • Case 59: 29-years old - left posterior parietal bone osteolytic lesion - brown tumor

• Spine

  • Lecture: Approach to Spine Biopsies - Tips and Tricks
  • Snippet: Why Every Infectious Spondylitis Needs a Biopsy - Three Recent Unusual Spine Infections
  • Craniovertebral Junction
    • Case 55: 32-years old - C1 lateral mass - posterior approach - tuberculosis
    • Case 72: 31-years old - C1 lateral mass - posterior approach - flexion to avoid vertebral artery - tuberculosis
  • Cervical
    • C2-C5
      • Case 54: 53-years old - C3 osteolytic lesion - posterolateral approach - plasmacytoma
    • C5-C7
      • Case 25: 41-years old - C6/7 infective disciitis - transthyroid approach - Streptococcus agalactiae
      • Case 26: 50-years old - C6/7 infective disciits - transthyroid approach - E.coli
  • Dorsal
    • Case 11: 16-years old - D3 transverse process lesion - Langerhans cell histiocytosis
    • Case 46: 75-years old - D12 body lesion - costovertebral approach - tuberculosis
    • Case 73: 59-years old - D2 body lesion - costovertebral approach - lymphoma
    • Case 131: 48-years old - D2/3 infectious spondylitis - transpedicular approach - Brucellosis
  • Lumbar
    • Case 3: 40-years old - L2 vertebral lesion - perivertebral biopsy and psoas aspiration - tuberculosis
    • Case 49: 75-years old - L4 body lesion - transpedicular approach - melanoma metastasis
    • Case 68: 26-years old - L3 body lesion - transpedicular approach and perivertebral soft tissue - tuberculosis
    • Case 75: 49-years old - L5/S1 discitis - transsacral posterolateral approach - no specific diagnosis
    • Case 85: 66-years old - L4/5 discitis - posterolateral perivertebral approach - post-operative spine - Candida fungal infection
  • Sacrum
    • Case 74: 66-years old - S1 body lesion - posterior approach - Ewing sarcoma
    • Case 86: 26-years old - L5/S1 infectious spondylitis - S1 ala biopsy - Coccidiodes immitis infection

• Sacroiliac (SI) Joints

  • Case 60: 63-years old - sacroilitis - prone approach - MRSA Staphylococcus aureus infection
  • Case 61: 29-years old - sacroilitis - prone approach - tuberculosis
  • Case 65: 22-years old - sacroilitis - prone approach - tuberculosis
  • Case 84: 20-years old - sacroilitis - prone approach - transosseous - transiliac bone - tuberculosis

• Chest Wall

  • Axilla
    • Case 27: 79-years old - right axilla, chest wall recurrent mass - de-differentiated liposarcoma
  • Ribs
    • Case 105: 63-years old - expansile rib lesion - plasmacytoma
      Case 132: 70-years old - sclerotic rib lesion - metastasis from Ca breast
  • Intercostal Space
    • Case 139: 38-years old - chest wall & intercostal space lesion involving ribs - transpleural collection approach - metastasis from Ca tongue
  • Costal Cartilage & Costochondral Junction
    • Case 136: 48-years old - 1st costal cartilage and costochondral osteolysis - tuberculosis
  • Sternum
    • Case 14: 50-years old - osteolyic manubrial sternal lesion - metastasis
  • Scapula
    • Case 13: 65-years old - mixed osteolytic-sclerotic glenoid lesion - metastasis
  • Clavicle
    • Case 116: 21-years old - sclerotic clavicular lesion - chronic nonbacterial osteitis

• Bony Pelvis

  • Case 10: 26-years old - right ischial tuberosity biopsy - Langerhans cell histioytosis (LCH)
  • Case 12: 74-years old - multifocal osteolytic and osteosclerotic bone lesions - right iliac bone osteolytic lesion - non-Hodgkin's lymphoma
  • Case 64: 49-years old - multifocal osteolytic and osteosclerotic bone lesions - repeat biopsy done from osteolytic and sclerotic foci - three sites - lymphoma
  • Case 94: 47-years old - iliopubic ramus biopsy using railroading - squamous cell metastasis from buccal carcinoma

Appendicular Skeleton

• Lecture

  • Approach to MSK Biopsies

• Bones & Joints

  • Upper Extremity
    • Case 9: 8-years old - distal radius osteolytic lesion - chronic nonbacterial osteitis
    • Case 129: 31-years old - proximal humerus and adjacent soft tissues mass with literature review - extraskeletal mesenchymal chondrosarcoma
  • Lower Extremity
    • Case 66: 60-years old - distal femur lesion - clear cell chondrosarcoma
    • Case 121: 28-years old - transtrochanteric biopsy of femoral neck lesion - Langerhans cell histioyctosis

• Soft Tissues

  • Upper Extremity
  • Lower Extremity
    • Case 28: 51-years old - thigh mass - high-grade liposarcoma

Head & Neck

• Suprahyoid

  • Case 23: 23-years old - sphenoid bone lesion - subzygomatic approach - adenoid cystic carcinoma
  • Case 24: 66-years old - oropharygeal mass - paramaxillary approach - non-Hodgkin's lymphoma
  • Case 78: 47-years old - lateral pharyngeal/retropharyngeal mass - paramaxillary approach - metastasis
  • Case 113: 60-years old - intra-maxillary sinus biopsy - anterolateral approach - lymphoma
  • Case 123: 78-years old - nasopharyngeal mass - paramaxillary approach - inflammation
  • Case 133: 81-years old - deep parotid lesion biopsy - retromandibular, premastoid approach - oncocytoma

• Infrahyoid

  • Case 92: 58-years old - cervical esophageal mass biopsy - transthyroid approach - squamous cell carcinoma

Ablations

Radiofrequency Ablation (RFA)

• Bone

  • Osteoid Osteoma
    • Case 7: 15-years old - tibial osteoid osteoma RFA
    • Case 40: 20-years old with pars interarticularis spine osteoid osetoma RFA
    • Lecture: Osteoid Osteomas - Treatment Methods Focusing on RFA, etc.
  • Chondroblastoma
  • Osteoblastoma
  • Metastases

• Lung

  • Case 41: 55-years old - right perihilar lung adenocarcinoma RFA
  • Case 120: 67-years old - right upper lobe adenosquamous carcinoma - 16.7 mmm nodule - RFA
  • Case 128 - RFA of small lung cancer - why is RFA not as popular as SBRT when the results are similar?

• Liver

  • Case 98: 56-years old - RFA small liver metastasis from neuroendocrine tumor

Cryoablation

• Liver

  • Case 52: 52-years old - cryoablation of liver metastasis

• Renal Tumors

  • Case 117: 42-years old - cryoablation of a small renal tumor in a solitary kidney
  • Case 135: 75-years old - cryoablation of a > 4.0 cm renal cell carcinoma

• Fibromatosis

  • Case 53: 46-years old - cryoablation of extra-abdominal thoracic wall desmoid-type fibromatosis
  • Case 103: 33-years old - cryoablation of pelvic fibromatosis

• Bone Tumors

  • Case 107: 20-years old - cryoablation of chondroblastoma

Tumor Injection Ablations

• Aneurysmal Bone Cyst

• Langerhans Cell Histiocystosis

  • Case 87: 26-years old - right ilium LCH - steroid injection for treatment

Steroid and Anesthetic Injections