Feasibility and Safety of the Craniocaudal Approach for Superior Sulcus Lesions of the Thorax

PURPOSE: To evaluate the feasibility and safety of the craniocaudal approach for superior sulcus lesions of the thorax. MATERIAL AND METHODS: Between October 2010 and December 2020, the data from 22 consecutive patients who underwent drainage or biopsy using a craniocaudal trajectory were retrospectively reviewed. The craniocaudal approach was applied for patients in which the fluid collection or tumor was limited to the superior thoracic sulcus lesion or otherwise inaccessible owing to intervening structures such as pleural dissemination. The indications for this procedure were drainage in 20 patients and biopsy in 2 patients. Technical success, procedure time, complications, and clinical success were evaluated. RESULTS: Technical and clinical success were achieved in all patients, and no major complications were found. The median procedure time was 25 min (range 15–40 min). This procedure was performed with fluoroscopic guidance in 11 patients and ultrasound guidance in 11 patients. The routes of needle passage were the first intercostal space (n = 16), the second intercostal space (n = 5), and between the clavicle and the first rib (n = 1). CONCLUSION: The craniocaudal approach for superior sulcus lesions might be a safe and feasible option for patients in which the conventional intercostal approach is difficult. LEVEL OF EVIDENCE: Retrospective cohort study. Level 4.