[Simple localization of peripheral pulmonary nodules - CT-guided percutaneous hook-wire localization].
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) is an alternative approach to small intrapulmonary nodules, if transbronchial or percutaneous biopsy have failed. We investigated the feasibility and effectiveness of the percutaneous CT-guided placement of hook-wires to localize such nodules before video-assisted thoracoscopy.


METHODS
19 patients with new by diagnosed intrapulmonary nodules underwent CT-guided hook-wire localization by application of a X-Reidy -Set (Cook, Inc., Bjaeverskov, Denmark). The average age of the patient was 63 years (range: 19 - 80 years), the mean distance between the nodule and the pleura visceral was 7.58 mm (range: 0 - 25 mm) and the mean diameter was 11.58 mm (range: 5 - 25 mm). After localization, the patients underwent a VATS resection of the lesion within a mean time of 30 min (range 10 - 48 min).


RESULTS
In all cases, resection of the nodules was successful. In 4 older patients the marking was complicated by poor cooperability. At the end of manipulation the end of the hook was distanced from the nodule. But also in these cases, resection was successfully performed. 8 patients developed an asymptomatic pneumothorax: 5 of them in a minor (max. 1.5 cm rim), three of them in a moderate (max. 3 cm rim) dimension. In 4 patients, in whom the tumor was hit directly by the needle, local bleeding occurred. In one case, haemoptoe was present. In no patient did a dislocation of the hookwire-system occur.


CONCLUSIONS
CT-guided placement of a hook-wire system is a simple and reasonable procedure which facilitates safe VATS resection of small pulmonary nodules.
Poretti
F P
FP
Institut für diagnostische und interventionelle Radiologie des Klinikums Ingolstadt, Germany. Frank.Poretti@Klinikum.Ingolstadt.de
Brunner
E
E
Vorwerk
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*