Introduction: To present 3 cases were a paravertebral approach had to be used for the biopsy of posterior and centrally located pulmonary nodules. Case presentation: Three patients underwent percutaneous CT-guided transthoracic biopsy of pulmonary nodules that were initially thought to be inaccessible because of their central, posterior location by a paravertebral approach. The first 2 patients had a history of extra thoracic malignancy and the third patient presented with a bone metastasis and an isolated pulmonary nodule in the right lower lobe, corresponding to potential stage IV lung cancer. Biopsy was feasible in all 3 patients using the paravertebral approach. Pulmonary metastases were confirmed in the first 2 patients, while a TTF-1 positive pulmonary adenocarcinoma was diagnosed in the last patient. No complications occurred. Conclusion: A paravertebral approach is feasible for posterior and centrally located pulmonary nodules.