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Purposeful creation of a pneumothorax and chest tube placement to facilitate CT-guided coil localization of lung nodules before video-assisted thoracoscopic surgical wedge resection.
J Vasc Interv Radiol. 2014 Jul; 25(7):1133-8.JV

Abstract

PURPOSE

To evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)-guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection.

MATERIALS AND METHODS

From May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42-76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications.

RESULTS

There were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5-35 mm), and average size was 13 mm (range, 7-30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions.

CONCLUSIONS

Pneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery.

Authors+Show Affiliations

Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Rd., Burlington, MA 01805. Electronic address: drshams241@gmail.com.Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Rd., Burlington, MA 01805.Department of Thoracic Surgery, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Rd., Burlington, MA 01805.Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Rd., Burlington, MA 01805.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

24788210

Citation

Iqbal, Shams I., et al. "Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-guided Coil Localization of Lung Nodules Before Video-assisted Thoracoscopic Surgical Wedge Resection." Journal of Vascular and Interventional Radiology : JVIR, vol. 25, no. 7, 2014, pp. 1133-8.
Iqbal SI, Molgaard C, Williamson C, et al. Purposeful creation of a pneumothorax and chest tube placement to facilitate CT-guided coil localization of lung nodules before video-assisted thoracoscopic surgical wedge resection. J Vasc Interv Radiol. 2014;25(7):1133-8.
Iqbal, S. I., Molgaard, C., Williamson, C., & Flacke, S. (2014). Purposeful creation of a pneumothorax and chest tube placement to facilitate CT-guided coil localization of lung nodules before video-assisted thoracoscopic surgical wedge resection. Journal of Vascular and Interventional Radiology : JVIR, 25(7), 1133-8. https://doi.org/10.1016/j.jvir.2014.03.010
Iqbal SI, et al. Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-guided Coil Localization of Lung Nodules Before Video-assisted Thoracoscopic Surgical Wedge Resection. J Vasc Interv Radiol. 2014;25(7):1133-8. PubMed PMID: 24788210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Purposeful creation of a pneumothorax and chest tube placement to facilitate CT-guided coil localization of lung nodules before video-assisted thoracoscopic surgical wedge resection. AU - Iqbal,Shams I, AU - Molgaard,Christopher, AU - Williamson,Christina, AU - Flacke,Sebastian, Y1 - 2014/04/29/ PY - 2013/11/20/received PY - 2014/03/05/revised PY - 2014/03/11/accepted PY - 2014/5/3/entrez PY - 2014/5/3/pubmed PY - 2015/2/20/medline KW - VATS KW - video-assisted thoracoscopic surgery SP - 1133 EP - 8 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 25 IS - 7 N2 - PURPOSE: To evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)-guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection. MATERIALS AND METHODS: From May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42-76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications. RESULTS: There were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5-35 mm), and average size was 13 mm (range, 7-30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions. CONCLUSIONS: Pneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/24788210/Purposeful_creation_of_a_pneumothorax_and_chest_tube_placement_to_facilitate_CT_guided_coil_localization_of_lung_nodules_before_video_assisted_thoracoscopic_surgical_wedge_resection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(14)00311-X DB - PRIME DP - Unbound Medicine ER -