# CT-guided periaortic lymph node biopsy



## bda23054 (Oct 31, 2012)

PREOPERATIVE DIAGNOSIS
Paraaortic lymphadenopathy.

POSTOPERATIVE DIAGNOSIS
Paraaortic lymphadenopathy.

NAME OF PROCEDURE 
CT-guided periaortic lymph node biopsy.  

INDICATION
This was an 81-year-old male who has had a long history with some renal failure and some weight loss, so the patient first started out with an ultrasound with Dr. Cheema and they noted a paraaortic lymph node.  This was better defined on a CT scan ordered by Dr. Wang which noted a large 6 cm paraaortic lymph node.  There was also multiple mesenteric lymph nodes that were somewhat concerning, and because of this Dr. Wang asked for CT-guided biopsy.

DESCRIPTION OF PROCEDURE
So the patient was brought to the CT Suite, placed in the prone position.  Radiopaque marker was placed on the left side in the suspected area of this large lymph node.  This area was then scanned with the radiopaque marker placed and marked at the skin level with skin marker.  This area was then prepped and draped in the usual sterile fashion, injected with 1% Lidocaine with epinephrine to the skin and subcutaneous tissue and into the psoas muscle on the left side.  The anesthetic needle was left in place and then did verify proper positioning and trajectory for biopsy of the paraaortic lymph node.  The trajectory was such that it was directed away from the renal vasculature and also the aorta.  Anesthetic needle was then removed and exchanged for a 19-gauge 14-cm needle, which then again under CT-guidance was placed at the edge of the lymph node and this was buried to the hub of the needle.  The biopsy monoptic 20-gauge 1.7 cm throw was then placed through the placement needle and fired 4 times.  Noted to have good specimen return on all firings and this was sent off in formalin to Pathology.  The needle was then slowly removed and CAT scans again were done verifying removal without any bleeding from the site.  The needle was then removed and a Band-aid was placed and the patient was laid in the prone position for approximately another 4 minutes.  A final CAT scan was done verifying no bleeding.  The patient throughout the procedure denied any shortness of breath, lightheadedness, or vital sign change.  The patient tolerated the procedure well and was wheeled back to multi-service for observation.


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## jmcpolin (Oct 31, 2012)

38505
77012


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## LMFOUTS (Jul 2, 2021)

Current coding recommendations are to use 49180, plus 77012 for the CT guidance.


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