We report a pulmonary infarction in 68-year-old man who was referred for an asymptomatic pulmonary nodule in chest radiography. Computed tomography (CT), positron emission tomography (PET), and transthoracic needle aspiration suggested suspicion for malignancy. Video-assisted thoracoscopic surgery (VATS) was performed for histologic diagnosis. Our case is a pulmonary nodule due to pulmonary infarction diagnosed by VATS in Korea.
Aged ; Humans ; Male ; Pulmonary Infarction/*complications ; Solitary Pulmonary Nodule/*etiology ; Thoracic Surgery, Video-Assisted

OBJECTIVETo arrive at correct diagnosis of pulmonary solitary nodule by clinical manifestation and chest CT scan.

METHODSNinety-eight patients with pulmonary solitary nodule were treated from 1990 to 2000. Their CT findings with clinical manifestations were correlated with the pathology results.

RESULTSOf 98 patients, there were 46 (46.9%) lung cancers, 14 (14.3%) benign tumors, 38 (38.8%) tuberculosis. Fifty-six (57.1%) patients had been asymptomatic or only associated with cough and sputum. 50% of these patients had stage I lung cancer. Tuberculosis was diagnosed more frequently in young patients with protracted feverishness, night sweats, chest and back pain, whereas lung cancer was more common in older patients who were asymptomatic or associated only with cough, sputum and hemoptysis. Lesions with well-defined margin, smooth and in the middle lobe by chest CT was suggestive of benign tumor, while those with irregular margin, un-even density, spiculated margin, lobulated contour and pleural shrinkage were more commonly associated with lung cancer. Those with calcification and in the lower lobe implied tuberculosis.

CONCLUSIONScreening of high risk population is useful in finding early lung cancer. Pulmonary solitary nodule can be correctly diagnosed chiefly by referring to the clinical manifestations and characteristics of chest CT scans. Nodules less than 1cm across are difficult to diagnose and, therefore, exploration is indicated.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Radiography, Thoracic ; Solitary Pulmonary Nodule ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnostic imaging ; etiology

OBJECTIVEVideo-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS.

METHODSHookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated.

RESULTSAll the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 +/- 3.08 mm in diameter, and the mean distance from lesion to parietal pleura was 10.09 +/- 2.62 mm. The mean localization time was 20.18 +/- 7.16 min, and then the nodules were removed by VATS within 18 +/- 6.65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed.

CONCLUSIONThe preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.

Adenocarcinoma ; diagnostic imaging ; surgery ; Adult ; Female ; Granuloma ; diagnostic imaging ; surgery ; Humans ; Lung Diseases ; diagnostic imaging ; surgery ; Lung Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Pneumonectomy ; Pneumothorax ; etiology ; Preoperative Period ; Radiography, Interventional ; Solitary Pulmonary Nodule ; diagnostic imaging ; surgery ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods ; Thoracoscopy ; Tomography, X-Ray Computed ; Young Adult