title: CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules.
abstract: BACKGROUND
  In preoperative lipiodol marking for small pulmonary nodules, lipiodol has a potential risk of distribution in the surrounding lung structure. There are no reports about the detailed accumulation and distribution of lipiodol.
  
  
  OBJECTIVE
  To evaluate computed tomography (CT) findings after lipiodol marking before thoracoscopic surgery for pulmonary nodules.
  
  
  METHODS
  Sixty-four consecutive CT-guided lipiodol markings for 103 nodules were performed in 55 patients. Lipiodol (0.2-0.4 mL) was injected using a 21-gauge needle near the nodule. The appearance of lipiodol spots was classified into the following three types on CT: type 1, dense; type 2, punctate; and type 3, unclear. The distribution of lipiodol was also investigated. Statistical analyses were performed on the accumulation and distribution related to nodule factors. Incidences of complications were also investigated.
  
  
  RESULTS
  A total of 110 markings were performed because of seven additional procedures due to insufficient marking. All nodules were successfully resected on the same day. The appearances of the lipiodol spots were type 1 (82%), type 2 (11%), and type 3 (7.3%). The areas of distribution were lung parenchyma (54%), central bronchus (39%), peripheral bronchovascular bundle (24%), needle tract (20%), pleural space (19%), another segment of ipsilateral lung (5.5%), and contralateral lung (0.9%). Distribution into pleural space and central bronchus was frequently seen in the shallow nodules (P < 0.05). Complications were pneumothorax (61%) and pulmonary hemorrhage (35%). There were no serious symptoms.
  
  
  CONCLUSIONS
  The appearance of the lipiodol spot was dense in most cases, despite frequent distribution in the surrounding lung structures without serious complications.
authors: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan miurak@koto.kpu-m.ac.jp.
authors: Hiroshi
authors: H
authors: Miura
authors: Department of Radiology, Kochi University, Kochi, Japan.
authors: Takuji
authors: T
authors: Yamagami
authors: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Osamu
authors: O
authors: Tanaka
authors: Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Rika
authors: R
authors: Yoshimatsu
authors: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Yusuke
authors: Y
authors: Ichijo
authors: Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Daishiro
authors: D
authors: Kato
authors: Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Junichi
authors: J
authors: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004998:Ethiodized Oil; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D011856:Radiographic Image Enhancement; D015641:Radiography, Interventional; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil
keywords: Localization; interventional; lung