title: Lung nodules in children: video-assisted thoracoscopic surgical resection after computed tomography-guided localization using a microcoil.
abstract: BACKGROUND
  Lung nodules that develop in children with cancer may represent metastatic disease or other conditions potentially requiring aggressive treatment. Thoracoscopic methods have been used for nodule resection; however, lesions deep in the lung parenchyma can be difficult to visualize. Fluoroscopic-guided thoracoscopic surgical resection after computed tomography (CT)-guided localization using microcoils has been described in the adult literature and has the potential to assist in the resection of deep pulmonary nodules in children.
  
  
  METHODS
  Six patients (ages 6-15 years) with an undiagnosed pulmonary nodule were treated using a combined CT-guided microcoil localization/fluoroscopic video-assisted thoracoscopic surgical technique. Preoperatively, a platinum-fibered microcoil was deployed with the deep end of the coil placed either through or in the vicinity of the pulmonary nodule and the superficial end coiled on the pleural surface. The nodule and coil were then resected with endoscopic staplers guided by fluoroscopy and video-assisted thoracoscopic surgical.
  
  
  RESULTS
  Computed tomography-guided microcoil localization and fluoroscopic-guided thoracoscopic resection were successful and critically influenced the management of all patients. Three patients were diagnosed with malignancy (2 metastatic diseases and 1 Hodgkin disease). A diagnosis of nonmalignant disease was made in 3 patients (granuloma, eosinophilic granuloma, and aspergilloma).
  
  
  CONCLUSIONS
  In the pediatric population, we have successfully applied a previously described adult technique using CT-localized microcoils to direct fluoroscopic-guided thoracoscopic surgical resection of pulmonary nodules.
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver V6H 3V4, Canada. mheran@cw.bc.ca
authors.forename: Manraj K S
authors.initials: MK
authors.lastname: Heran
authors.forename: Bippan S
authors.initials: BS
authors.lastname: Sangha
authors.forename: John R
authors.initials: JR
authors.lastname: Mayo
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Blair
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D015641:Radiography, Interventional / Q000295:instrumentation*; D018570:Risk Assessment; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome