This 38-years old had carcinoma tongue and presented with left pleural effusion. A PET/CT showed erosions of the left 7th and 8th ribs with soft tissue along the endosteal surfaces.
It was a toss up between going straight in from the mid / posterior axillary line (green arrow) versus cutting across the pleural effusion and targeting the soft tissue internally. I finally chose the latter approach (red arrow), with an 18G coaxial biopsy gun, just to ensure that I could get adequate material and did not have to go through the rib or the neurovascular bundle.
The diagnosis was squamous cell metastasis constant with tongue primary.