Mediastinal mass biopsy - transcostal approach

This is a 20-years old lady who presented with a mediastinal mass, predominantly in the aorto-pulmonary window. A CT-guided biopsy was suggested.

On the contrast-scan, it was possible to delineate the aorta and pulmonary arteries separate from the mass with a 1cm wide window between the two (Figs. 1, 2). Using a transcostal approach (Fig. 3), the cannula was slowly advanced (Fig. 4), until it lay within the centre of the mass, away from the vessels and bronchus. A biopsy was then performed (Fig. 5). This turned out to be lymphoma.