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CT-guided biopsy of spinal lesion
25%
283/1117
Percutaneous kyphoplasty
1%
8/1117
External beam radiation
3%
39/1117
Intravenous antibiotics
14/1117
Arteriography and embolization of the spinal lesion
69%
769/1117
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The CT of the abdomen shows a renal mass. Renal cell carcinoma is extremely hypervascular and has a propensity to bleed profusely. Thus, many authorities recommend arteriography and embolization of the lesion prior to performing any surgery on a suspected renal metastatic lesion. The goal is to reduce blood loss in patients undergoing surgery for these hypervascular tumors. There is no need for a CT guided biopsy for several reasons: 1) because our suspicion is high for metastatic renal disease 2) decompression is indicated and we can obtain a biopsy during decompression 3) biopsies of metastatic renal lesions can lead to excessive bleeding. Percutaneous kyphoplasty and radiation would not alleviate her radicular symptoms and are not indicated. Her clinical picture and MRI are not characteristic of infection, and therefore antibiotics would not be indicated. Sundaresan et al performed a case-control study of patients with renal mets to the spine treated with radiation alone or surgery +/- radiation. The median survival of the surgically treated patients was 13 months, compared with 3 months for those treated by radiation alone. In addition, a greater proportion of the surgically treated patients were benefitted neurologically (70%) compared with those treated by radiation (45%).
2.6
(56)
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