BMUS Publications

Combined Prospective and Retrospective assessment of haematoma formation post percutaneous ultrasound non-targeted transthoracic liver biopsy

Wajiha Arshad, Hull University Teaching Hospitals NHS Trust

Aims and Objectives 

  • To assess the frequency of haematoma formation post ultrasound guided liver biopsy, and the sequelae
  • Can we change the current standard in our hospital to combine all cases to one single medical day unit

Methods:

  • An audit tool was created for obtaining and collecting data regarding indications for a liver biopsy, how many attempts were made, how many cores taken and if there were any immediate post procedural complications
  • 4 months of data was used
  • 2.5 months of data was used retrospectively and if there was any follow up in terms of scans or admissions following complications of the biopsy this was also noted
  • 1.5 months of data was collected prospectively with a radiology registrar using a portable ultrasound scanner to assess for haematoma formation 2-4 hours post procedure

Results:

  • 31 patients were included in this audit, 10 were prospectively assessed and 21 were retrospectively assessed using online patient records and the PACS system to note any follow up scans
  • In terms of indications for the biopsy, the two largest indications were 32% patients had a biopsy for NAFLD & NASH and 26% had a biopsy for metastatic disease seen on previous scans
  • The number of cores taken varied from 1-4 in a single sitting
  • 10/31 male 32%
  • 21/31 female 78%
  • 100% patients did not have any immediate post procedural complications (pain, hypotension, vasovagal, perforation)
  • 0% of scanned patients had a haematoma
  • 1 patient had significantly deranged clotting and received 4 units of Fresh Frozen Plasma prior to the biopsy
  • 11 patients underwent further imaging
  • 5 tumour staging
  • 2 routine? fibrosis ultrasounds
  • 1? ascites (2 months post biopsy)
  • 1 CTKUB
  • 1 MRCP – GB calculus (?medication)

Conclusion:

  • Excellent post biopsy haematoma rates
  • Although a small sample, results are encouraging
  • Scope for reshaping services and improving patient pathway which is currently being analysed

View the poster here