title: Missed pulmonary metastasis.
abstract: OBJECTIVE
  To assess the rate of detection of pulmonary nodules on preoperative computed tomography, based on intraoperative palpation of non-imaged pulmonary nodules, in patients who underwent thoracotomy for metastasectomy with bimanual lung palpation.
  
  
  METHODS
  A retrospective study carried out on all cases of pulmonary metastasectomy performed in King Faisal Specialist Hospital and Research Center over a 10-year period (2001-2011). The number of nodules detected on preoperative computed tomography by a radiologist was compared with the number of nodules identified on pathology. Resected pulmonary nodules were classified to benign or malignant. Secondary outcomes were operative approach and primary malignancy.
  
  
  RESULTS
  215 metastasectomies were performed by thoracotomy. The incidence of nodules that were not imaged preoperatively was 36% (41% of mesenchymal tumors, 28% of epithelial tumors).
  
  
  CONCLUSIONS
  Metastasectomy by an open approach, which affords bimanual palpation of the entire lung, discovered ipsilateral non-imaged malignant pulmonary metastases in 36% of cases (41% of mesenchymal tumors).
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Khalid Turki
authors.initials: KT
authors.lastname: Althagafi
authors.forename: Omniyah Abdullah
authors.initials: OA
authors.lastname: Alashgar
authors.forename: Huda Saddig
authors.initials: HS
authors.lastname: Almaghrabi
authors.forename: Awrad
authors.initials: A
authors.lastname: Nasralla
authors.forename: Mohamed Hussein
authors.initials: MH
authors.lastname: Ahmed
authors.forename: Ameen Mohammad
authors.initials: AM
authors.lastname: Alshehri
authors.forename: Waleed Neamatallah
authors.initials: WN
authors.lastname: Saleh
authors.forename: Khaled Manae
authors.initials: KM
authors.lastname: Alkattan
mesh_terms: D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D010173:Palpation; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012529:Saudi Arabia; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diagnostic errors; X-ray computed; lung neoplasms; pulmonary surgical procedures; radiographic image enhancement; tomography