Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results.

PURPOSE: To assess the utility of artificial widening of the extrapleural space to gain an extrapleural biopsy access route to the anterior and posterior mediastinum.

MATERIALS AND METHODS: The authors retrospectively analyzed the findings in 20 patients who underwent biopsy of mediastinal masses after dilation of the extrapleural space with injection of approximately 20 mL of physiologic saline solution. The solution was injected to provide ventral (n = 6) or dorsal (n = 14) extrapleural access to the mediastinum. Biopsies were performed under computed tomographic guidance.

RESULTS: Right-sided paravertebral extrapleural access to the mediastinum was achieved in 11 of the 14 patients in whom a dorsal approach was used. The paravertebral extrapleural soft tissue was dilated from a mean of 0.2 cm to a mean of 0.9 cm. Extrapleural biopsy was performed in nine patients. The pleura was traversed in four patients, causing pneumothoraces in two. A parasternal access route was created in all six patients in whom a ventral approach was used, and biopsies were performed without complications. The minimal width of the anterior mediastinum in these six patients increased from a mean of 2.8 cm to a mean of 4.6 cm with dilation.

CONCLUSION: Artificial widening of the extrapleural space provides an access route to the anterior and posterior mediastinum for large-bore biopsy.