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Deep liver FNA tips

Hi all –

Does anyone have any tips for those small liver and/or deep liver lesions in large deep chested dogs that are just hard to hit with a needle? If I’m intercostal, I’m struggling with rib shadowing and sometimes lung shadows as the animal takes a deep breath. If I’m subxiphoid, I’m standing on my head to get the needle in the right plane. I just hate trying to get these. I’m generally using a 22 g long needle. Any tips?

Hi all –

Does anyone have any tips for those small liver and/or deep liver lesions in large deep chested dogs that are just hard to hit with a needle? If I’m intercostal, I’m struggling with rib shadowing and sometimes lung shadows as the animal takes a deep breath. If I’m subxiphoid, I’m standing on my head to get the needle in the right plane. I just hate trying to get these. I’m generally using a 22 g long needle. Any tips?

PS. Pic is just an example of what I finally got yesterday after cursing and finding a 1.5″ needle almost too short when going intercostal on a large fat dog.

Liz

Liz

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4 responses to “Deep liver FNA tips”

  1. I know the feeling! Deep

    I know the feeling! Deep chested patients, whether they are fat or skinny, are the most challenging to FNA. Its virtually impossible to go subxiphoid unless the lesion is in the ventrocaudal liver. 

    Aside from using 22-25 ga 1.5″ needles, you can use spinal needles with stylets if you have a lot of tissue to transverse to hit an area in the deep liver. Some pressure with the probe hand I think helps somewhat to eliminate shadowing. Obviously sedation helps to slow down breathing. 

    Having said that, sometimes you just cant hit the area so I dont force it and maybe consider laproscopic biopsy or open laparotomy if needed. 

     

  2. us sdep positions 9, 10 and

    us sdep positions 9, 10 and 12, 13 stay ventral toward the sternum or bottom 1/3 of the post diaphragmatic rib cage as the lungs are up high. Use a microconvex probe lined up between the ribs. I can’t remember the last time i needed a spinal needle as you can usually get to any lesion right or left with this positonal approach and a 1.5 inch needle. But a spinal needle or use the stylet of a long iv catheter as well if need be.

  3. Hi Liz! 
    I find utilizing my

    Hi Liz! 

    I find utilizing my support staff can be super helpful!  Having a well sedated patient, and then having a tech push on both sides of where you are going to do the aspirate, will help with ‘minimize the territory’ and get you a bit closer to the area you want to aspirate, espeically on those very obese patients. 

    Also, playing musical patient, and flipping both R and L and VD to see if there is a much better way to approach the lesion in question. 

     

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