Transvenous biopsy of body cistyc lesions in a 32-year-old man with cloves syndrome and thrombocytopenia: a safe option for high bleeding risk patients.

introductionImage guided percutaneous biopsy is a standard in interventional radiology but can be limited by anatomical or clinical factors. Alternative techniques, such as transvenous biopsy, can aid in cases with these constraints, particularly in patients with thrombocytopenia. CASE PRESENTATION: A 32-year-old male with PIK3CA related overgrowth syndrome presenting as Congenital, Lipomatous, Overgrowth, Vascular malformations, Epidermal nevi, Spinal/skeletal anomalies and/or scoliosis (CLOVES) syndrome, was admitted to the emergency department with bleeding cystic lesions and severe thrombocytopenia. The initial medical approach for patients with thrombocytopenia must be supported by a genetic or histopathologic examination, as required by insurance protocols. Percutaneous fine-needle biopsy often has low diagnostic yield in such cases. Due to the high risk of bleeding associated with thrombocytopenia and the vascular nature of the cystic lesions, direct percutaneous biopsy was contraindicated. Instead, a transvenous biopsy was performed by accessing the lesion through a venous route under image guidance, allowing for safe tissue sampling without the risk of significant hemorrhage. This approach confirmed PIK3CA involvement and guided subsequent treatment.

conclusionsTransvenous biopsy serves as a safe and effective alternative to standard percutaneous biopsy in high-risk patients with thrombocytopenia and vascular lesions, enabling accurate diagnosis while minimizing bleeding complications.