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Keep in mind that the position of the liver may change in the time interval between preliminary scanning and the actual biopsy. This is often due to changes in depth of ­respiration after the patient has been sedated. Smaller respiratory excursions in sedated patients often result in the liver ­assuming a higher position in the right upper quadrant, such that initial subcostal or subxiphoid trajectories are lost after the patient becomes sedated. When this occurs, an intercostal approach is obligatory.

In general, most PADs require the following components: access needle, directional catheter, guidewire(s), fascial dilators, and drainage catheter. Needles Access needles range in size from 22- to 18-gauge. They can be biopsy type or sheathed needles of variable length. 038" guidewire. 038" guidewire. Guidewires Guidewires are used to secure percutaneous access to c­ ollections. When Seldinger drainages are performed, the guidewire establishes percutaneous access to the collection and is necessary for deployment of the catheter into the ­collection.

Price R, Bernardino M, Berkman W, Sones PJ, Torres W. Biopsy of the right adrenal gland by the transhepatic approach. Radiology. 1983;148(2):566. 46. Mody M, Kazerooni E, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995;19(3):434–9. 47. Kane N, Korobkin M, Francis IR, Quint L, Cascade P. Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach. AJR Am J Roentgenol. 1991;157(4):777–80.

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A system development method by Jackson M.A

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