This 8-years old girl had progressive right paratracheal adenopathy along with neck nodes from February 2020. The neck nodes were biopsied with imaging guidance and excision on two different occasions respectively and were negative for a specific diagnosis.

The physicians were left with the growing right paratracheal node. Given the problems currently with emergency admission in hospitals, the idea was to reduce the chance of any complication to a bare minimum.

In the prone position, with sedation (because she is 8 years old), I first advanced the 20G cannula into the space between the pleura and vertebral body and injected a combination of saline and lignocaine and created a path for the biopsy. I then changed the skin insertion point and advanced the cannula up to the edge of the fluid created space and injected again to create more space and then advanced the needle straight into the node without going through the pleura or lung.

This doesn’t always work for paratracheal nodes, as we will see tomorrow, especially in adults. But when it does, it allows us to biopsy these nodes using an extra-pleural approach safely and easily.

The diagnosis was granulomatous disease of unknown etiology, which will be further sorted out clinically. The microbiology did not yield an answer as well. Lymphoma and other malignancies however are conclusively ruled out.