title: Combined sonographic and fluoroscopic guidance during transjugular hepatic biopsies performed in children: a retrospective study of 74 biopsies.
abstract: OBJECTIVE
  Our aim was to evaluate the safety, effectiveness, and clinical impact of transjugular biopsies of the liver performed in children.
  
  
  METHODS
  We retrospectively reviewed 74 transjugular hepatic biopsies performed in 64 pediatric patients. The selection criteria for transjugular approach in these children included mainly coagulopathy, thrombocytopenia, or ascites. The last 37 biopsies in our series were performed with combined sonographic and fluoroscopic guidance, which improved visualization of the biopsy tract.
  
  
  RESULTS
  Adequate samples for histopathologic analysis were obtained in all except one case (98.6%). In most patients with fulminant hepatic failure, biopsy results allowed patients to be promptly listed for orthotopic liver transplantation; in patients with less severe hepatic failure, biopsy results helped guide medical management. In patients with liver transplants, the biopsy provided information on acute graft rejection; in patients who had undergone bone marrow transplantation, the biopsy helped to determine the status of graft-versus-host disease. One death occurred immediately after the procedure but at autopsy was deemed not to have been caused by the biopsy itself. Overall, procedural complications occurred in 8.1% of patients. Complications included neck hematomas, small subcapsular hematomas, subclavian artery puncture, and extravasation of contrast material into the retroperitoneum.
  
  
  CONCLUSIONS
  Transjugular hepatic biopsy is a relatively safe procedure that has considerable impact on patient treatment. The addition of sonographic guidance during the biopsy improves visualization, increases operator confidence, and allows the performance of biopsies in smaller patients and in children with reduced liver transplants.
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Habdank
authors.forename: Ricardo
authors.initials: R
authors.lastname: Restrepo
authors.forename: Vicky
authors.initials: V
authors.lastname: Ng
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Temple
authors.forename: Joao
authors.initials: J
authors.lastname: Amaral
authors.forename: Peter G
authors.initials: PG
authors.lastname: Chait
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007601:Jugular Veins; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D014463:Ultrasonography