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Trucut Biopsy of a Solitary Focal Metastatic Superior Vena Cava Thrombus via Percutaneous Transjugular Approach Using Real-Time Fluoroscopic Needle Visualization in Two Planes

Presentation of metastasis as a solitary focal lesion at an intravascular location is encountered quite infrequently. Owing to its intravascular location, accessing the lesion for sampling and obtaining an adequate amount of tissue are technically difficult. Among the various methods of obtaining an adequate sample from intravascular lesions, scoop and trucut biopsies appear to be safer and more advantageous. The authors present a case of a 65-year-old woman with symptoms of superior vena cava syndrome secondary to a solitary focal fluorodeoxyglucose (FDG)–avid thrombus within the superior vena cava lumen 14 years after complete remission of breast carcinoma. This lesion was approached via transjugular venous access and biopsied under fluoroscopic guidance with continuous contrast injection and real-time needle visualization in two planes.