title: Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules.
abstract: OBJECTIVE
  Several techniques have been reported for the localization of small pulmonary nodules in thoracoscopic resection. In the present study we examined the usefulness and complications of computed tomography-guided lipiodol marking for thoracoscopic resection in our experience of 174 nodules.
  
  
  METHODS
  Computed tomography-guided lipiodol marking was performed on 174 nodules less than 30 mm in size. Of these nodules, 45 showed ground-glass opacity images and 129 showed solid images on computed tomography. The mean size of the nodules was 10 +/- 6 mm (range, 2-30 mm), and their mean depth from the pleural surface was 10 +/- 7 mm (range, 0-30 mm). One to 7 days before thoracoscopy, all of the nodules were marked with 0.4 to 0.5 mL of lipiodol by using computed tomography. The marked nodules were grasped with a ring-shaped forceps during fluoroscopy and resected by means of thoracoscopy.
  
  
  RESULTS
  All the nodules could be marked and localized by means of fluoroscopy as a clear spot during thoracoscopic surgery. Complications of the marking were chest pain requiring analgesia in 16 (11%) patients, hemosputum in 11 (6%) patients, pneumothorax in 30 (17%) patients, and hemopneumothorax in 1 (0.6%) patient. Eleven (6%) patients with pneumothorax required drainage, and the patient with hemopneumothorax required an emergency operation. No other complications were observed.
  
  
  CONCLUSIONS
  Lipiodol marking is a useful, safe, and inexpensive procedure for localizing ground-glass opacity lesions, small pulmonary nodules, or both for thoracoscopic resection.
authors.affiliation: Department of Thoracic Surgery, Saiseikai Central Hospital Tokyo, Tokyo, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kaji
authors.forename: Tsuguo
authors.initials: T
authors.lastname: Naruke
authors.forename: Keiichi
authors.initials: K
authors.lastname: Suemasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D005471:Fluoroscopy; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage / Q000009:adverse effects; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000601:surgery*; D013653:Tattooing / Q000379:methods*; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007459:Iodized Oil