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Abstract
With the progress of computed tomography (CT), the detection of small pulmonary nodules has been increased. The conventional diagnostic modalities for tissue confirmation, such as bronchoscopic biopsy or transthoracic needle biopsy, may not be successful in some cases. Too small a nodule or the nodules located far from the pleural surface can be marked and localized with device preoperatively and then this tissue can be obtained surgically. CT-guided hook wire fixation is useful in marking pulmonary nodules and there are few complications with this procedure. We report here on a case of double primary lung cancer that was diagnosed by percutaneous localization with using a hook wire.
References
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Figures
Fig. 1.
The initial chest CT scan showed (A) about a 1.7×1.5 cm sized well-defined nodule with a lobulated shape in the right upper lung (solid arrow) and (B) a well-defined small nodule in the left lower lung just beneath the pleura (solid arrow). (C) Before the operation, the small nodule (solid triangle) in the left lower lung was marked and localized with using a hook wire under CT guidance (white arrows). (D) Two years after the operation, the chest CT showed about 2.8 cm sized newly developed heterogeneously enhancing lesion in the left posterior chest wall (solid black arrow).
Fig. 2.
(A) The hook wire system is composed of a long cannula needle and a hook wire. When the cannula needle tip is placed in a proper position, the hook wire is advanced along the cannula. (B) The 20 gauge, 7.5 cm long cannula needle (top) and the hook wire (bottom). (C) Localization of the small nodule with the hook wire during video-assisted thoracoscopic surgery.
Fig. 3.
The report from the pathologist revealed (A) squamous cell carcinoma for the nodule of the right upper lobe (H&E stain, ×200) and (B) small cell carcinoma for the lesion in the left lower lobe, which was obtained by wedge resection after localization with using a hook wire (H&E stain, ×200). (C) The tumor cells for the nodule of left lower lobe were positive for chromogranin, which is an immunohistochemistry stain. (D) Two years after the operation, metastatic small cell carcinoma was shown from the pleural biopsy (H&E stain, ×200).
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