International Journal of Science and Healthcare Research DOI: https://doi.org/10.52403/ijshr.20210431 Vol.6; Issue: 2; April-June 2021 Website: ijshr.com Case Report ISSN: 2455-7587 International Journal of Science and Healthcare Research (www.ijshr.com) 174 Vol.6; Issue: 2; April-June 2021 CT Scan Guided Trans-Sternal Approach for Anterior Mediastinal Mass Biopsy Vishal N. Bakare 1 , Shubhasish Pattnaik 2 1 Faculty, Dr. D.Y.Patil Medical College, Hospital and Research Hospital, Pimpri, Maharashtra, India 2 Dr. D.Y.Patil Medical College, Hospital and Research Hospital, Pimpri, Maharashtra, India Corresponding Author: Vishal N. Bakare ABSTRACT Anterior mediastinal lesions which are directly posterior to the sternum and have no significant parasternal component are difficult to approach for biopsy. Very few cases of CT-guided trans- sternal mediastinal mass biopsy have been reported in the literature. We report two cases of CT guided trans-sternal mediastinal mass biopsy to highlight the importance of this technique. Keywords: CT scan, Mediastinal mass, Trans- sternal approach, Biopsy INTRODUCTION Anterior mediastinal lesions which are directly posterior to the sternum and have no significant parasternal component are difficult to approach for biopsy. Very few cases of CT-guided transsternal mediastinal mass biopsy have been reported in the literature. We report two cases of CT guided transsternal mediastinal mass biopsy to highlight the importance of this technique. CASE REPORT Case 1: 66 years old gentleman presented with on & off chest pain and swelling over face since 2 weeks. He was clinically examined & investigated with routine blood tests and X-ray of chest. X-ray chest revealed bilateral pleural effusion (Left>right). Ultrasound guided aspiration of left sided pleural effusion was done which revealed positive cytology for malignant cells. PET scan was done for further evaluation. It revealed metabolically active heterogeneously enhancing soft tissue lesion in anterior mediastinum (Figure 1 ) along with multiple mediastinal, axillary enlarged lymph nodes. Also, there were multiple metabolically active bilateral lung nodules along with skeletal lesions (Figure 2 ). So the overall picture was likely to be of gross metastatic disease. For histo- pathological diagnosis, CT guided anterior mediastinal biopsy was planned. On pre procedural CT scan, the lesion was completely retro-sternal with no para-sternal extension. Hence, we decided to go for trans-sternal oblique approach for the biopsy in order to avoid injury to great vessels (Figure 3 ). Multiple tissue cores were obtained successfully from the lesion with no intra and post procedural complications. The pathology report was suggestive of metastatic deposits of mucinous adenocarcinoma with signet cell morphology. The patient is now being managed on chemotherapy for the metastatic disease. Case 2: 23 years female patient presented with complaints of neck swelling, breathlessness and weight loss since 1 month. CT scan of the Thorax was done which revealed soft tissue mass involving superior and anterior mediastinum (Figure 4 ). It was closely abutting the great vessels and pericardium. As there was no significant parasternal component, CT scan guided trans-sternal biopsy was done and adequate samples taken (Figure 5 ). The