Artificial displacement of kidneys, spleen, and colon by injection of physiologic saline and CO2 as an aid to percutaneous procedures: experimental results.
OBJECTIVE
To determine whether displacement of the kidneys, spleen, or bowel with injection of fluids or CO2 can be used to create a direct and potentially safer access route to the retroperitoneum for large-bore needle biopsy or abscess drainage.


METHODS
In cadavers (n = 24), the kidneys were displaced laterally by means of computed tomography (CT)-guided paravertebral injection of 120 mL of physiologic saline solution (n = 18) and 120 cm3 of CO2 (n = 6). The spleen (n = 11) and retroperitoneal colon (n = 7) were also displaced with saline. Displacement of the organs from the needle tip was measured on CT scans.


RESULTS
After fluid injection the kidneys shifted 1.47 cm +/- 0.51, the spleen shifted 1.14 cm +/- 0.44, and the retroperitoneal colon shifted 1.38 cm +/- 0.37. The kidneys obstructed access to the para-aortic space in 17% of cases (four of 24 cases) and to the entire adrenal gland in 72% (13 of 18 cases) before saline injection and in 0% (zero of 24 cases) and 39% (seven of 18 cases), respectively, after injection. The result with fluid were significantly better than those with CO2 (P < .05).


CONCLUSIONS
Displacement of kidneys, spleen, or retroperitoneal colon with a saline injection is effective in gaining an access route for biopsy or abscess drainage. Potential for patient discomfort, decrease in target-lesion conspicuity, and adverse effects of absorbed fluid in patients with kidney or heart disease must be considered with use of this technique in the clinical setting.
Langen
H J
HJ
Department of Diagnostic Radiology, Technical University of Aachen, Germany.
Jochims
M
M
Günther
R W
RW
D000038:Abscess / Q000601:surgery; D000273:Adipose Tissue / Q000033:anatomy & histology; D000311:Adrenal Glands / Q000033:anatomy & histology; D001011:Aorta / Q000033:anatomy & histology; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D003106:Colon / Q000033:anatomy & histology*; D003287:Contrast Media / Q000008:administration & dosage; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007267:Injections; D007327:Insufflation; D007668:Kidney / Q000033:anatomy & histology*; D009339:Needles; D011677:Punctures; D015641:Radiography, Interventional; D012187:Retroperitoneal Space; D012965:Sodium Chloride / Q000008:administration & dosage*; D013154:Spleen / Q000033:anatomy & histology*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D002245:Carbon Dioxide; D012965:Sodium Chloride