Fig. 21.

Posterior paravertebral approach with saline instillation technique.

A. Contrast-enhanced CT scan of 21-year-old woman with multiple necrotic subcarinal nodes showed no extrapleural paravertebral window to lesion. B. 22-gauge chiba needle (thin arrow) was advanced into paravertebral extrapleural space and saline solution was injected. After widening extrapleural space, safe window (arrowhead) was created, and guiding needle (thick arrow) was advanced through this space. C. Final positioning of guiding needle was made to edge of nodal mass. Biopsy and culture reports were suggestive of granulomatous lesion due to mycobacterium tuberculosis.