Needle localization for thoracoscopic resection of small pulmonary nodules in children.
BACKGROUND
Children who have malignant disease and pulmonary nodules frequently need a tissue diagnosis to direct therapy. Computed tomography (CT)-guided needle localization and methylene blue marking allow thoracoscopic resection of nonvisible nodules.


METHODS
Malignant disease was diagnosed in three patients aged 2, 2.5, and 11 years. Pulmonary nodules seen on chest CT, representing either metastatic disease or infection developed in each patient. All lesions were 1 to 2 cm deep to the pleural surface, precluding thoracoscopic visualization. A Homer mammographic needle was placed near the lesion using CT guidance under general anesthesia. The pleura overlying the lesion was also marked with methylene blue. Under the same anesthetic, patients went to the operating room where the lesions were thoracoscopically resected.


RESULTS
Needle localization and methylene blue staining accurately localized the lesion in all cases. Thoracoscopic resection provided a diagnosis of metastatic disease or infection in all cases. There were no complications.


CONCLUSIONS
CT-guided needle localization of pulmonary lesions deep to the pleural surface, is a safe, accurate method for allowing thoracoscopic resection in these children who would otherwise need open thoracotomy for diagnosis.
Waldhausen
J H
JH
Department of Surgery, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105, USA.
Shaw
D W
DW
Hall
D G
DG
Sawin
R S
RS
D001706:Biopsy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008751:Methylene Blue; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed
D004396:Coloring Agents; D008751:Methylene Blue