Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection.
BACKGROUND
There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative.


METHODS
We injected 0.1-0.2 ml of Histoacryl (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle.


RESULTS
The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0-1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura.


CONCLUSIONS
CT-fluoroscopy guided injection of Histoacryl blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.
Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan.
J
J
Yoshida
K
K
Nagai
M
M
Nishimura
K
K
Takahashi
D000328:Adult; D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000601:surgery*; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed
D003487:Cyanoacrylates