This 35-years old lady had mediastinal and bilateral hilar adenopathy. She came for a CT guided biopsy.
I placed her prone hoping to do a standard subcarinal node biopsy, but I just could not find a safe window for an extra-pleural hydro-dissection. So I decided to biopsy the right paratracheal node.
I inserted the cannula hoping to do an extra-pleural biopsy with hydro-dissection, but somehow even after injecting saline mixed with lignocaine, the pleura did not move out of the way. Which is fine. Doing a trans-pulmonary node biopsy is not a big issue, so I went ahead with the trans-pulmonary route using a 20G coaxial biopsy gun.
The diagnosis was granulomatous disease, likely of mycobacterial etiology.