OBJECTIVE: This study was designed to evaluate follow-up results in terms of patient prognosis for malignant pulmonary nodules depicted as pure ground-glass opacity (GGO) lesion observed at high-resolution CT (HRCT). MATERIALS AND METHODS: Surgical removal for malignant GGO nodules was accomplished in 58 patients (26 men, 32 women; mean age, 57 years; age range, 29-78 years). Patient prognoses were assessed by patient clinical status and the presence of changes in nodule size determined after a follow-up HRCT examination. Differences in patient prognoses were compared for nodule number, size, surgical method, change in size before surgical removal, and histopathological diagnosis by use of Fisher's exact test and Pearson's chi-squared test. RESULTS: Of the 58 patients, 40 patients (69%) were confirmed to have a bronchioloalveolar carcinoma (BAC) and 18 patients (31%) were confirmed to have an adenocarcinoma with a predominant BAC component. Irrespective of nodule size, number, treatment method, change in size before surgical removal and histopathological diagnosis, neither local recurrence nor a metastasis occurred in any of these patients as determined at a follow-up period of 24 months (range; 12-65 months). Of 14 patients with multiple GGO nodules, all of the nodules were resected without recurrence in six patients. In the remaining eight patients, the remaining nodules showed no change in size in seven cases and a decrease in size in one case as determined after a follow-up CT examination. CONCLUSION: Prognoses in patients with pure GGO malignant pulmonary nodules are excellent, and not significantly different in terms of nodule number, size, surgical method, presence of size change before surgical removal and histopathological diagnosis.
Adenocarcinoma/pathology/radiography/surgery ; Adenocarcinoma, Bronchiolo-Alveolar/pathology/radiography/surgery ; Adult ; Female ; Humans ; Lung Neoplasms/pathology/*radiography/surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules/pathology/*radiography/surgery ; Prognosis ; Solitary Pulmonary Nodule/pathology/*radiography/surgery ; *Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. RESULTS: All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. CONCLUSION: CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.
Adult ; Aged ; Barium Sulfate/*diagnostic use ; *Contrast Media ; Female ; Humans ; Lung Neoplasms/radiography/*surgery ; Male ; Middle Aged ; *Radiography, Interventional ; Solitary Pulmonary Nodule/radiography/*surgery ; *Thoracic Surgery, Video-Assisted ; *Tomography, X-Ray Computed

Clear cell tumor of the lung is a rare and very unusual benign pulmonary tumor. As clear cell tumor of the lung contains abundant cytoplasmic glycogen, this tumor is called "sugar tumor". We report a case of sugar tumor in a 64-yr-old man presenting as a round pulmonary nodule. On dynamic computed tomography (CT) scans, the solitary pulmonary nodule showed early wash-in enhancement with an early washout pattern like a lung malignancy. The patient underwent wedge resection for the tumor. Pathologic examination, including immunohistochemical studies, revealed that the nodule was a benign clear cell tumor, so-called "sugar tumor". Because only a small number of cases have been reported previously, clinical aspects, radiological characteristics on dynamic contrast-enhanced CT, and differential diagnosis of the tumor are not well established. Herein we present a clear cell tumor of the lung and discuss the clinical, radiological, and pathological features of the tumor.
Antigens, Neoplasm/metabolism ; Diagnosis, Differential ; Humans ; Lung/radiography/surgery ; Lung Neoplasms/diagnosis/pathology/*radiography ; Male ; Middle Aged ; Neoplasm Proteins/metabolism ; Perivascular Epithelioid Cell Neoplasms/diagnosis/pathology/*radiography ; Solitary Pulmonary Nodule/diagnosis/pathology/*radiography ; *Tomography, X-Ray Computed

Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.
Animals ; Ethiodized Oil/*administration & dosage ; Fluoroscopy ; Injections, Subcutaneous ; Lung/*radiography/surgery ; Methylene Blue/*administration & dosage ; Preoperative Care ; Rabbits ; Solitary Pulmonary Nodule/*surgery ; Staining and Labeling/methods ; Thoracic Surgery, Video-Assisted/*methods ; Thoracoscopy/methods ; Tomography, X-Ray Computed

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

The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.
Aged ; Antibodies, Monoclonal, Murine-Derived/adverse effects/therapeutic use ; Antineoplastic Agents/adverse effects/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/therapeutic use ; Biopsy/methods ; Cyclophosphamide/adverse effects/therapeutic use ; Doxorubicin/adverse effects/therapeutic use ; Female ; Humans ; Lymphoma, Large B-Cell, Diffuse/drug therapy/microbiology ; Pneumocystis jirovecii/pathogenicity ; Pneumonia, Pneumocystis/*diagnosis/*radiography ; Positron-Emission Tomography ; Prednisone/adverse effects/therapeutic use ; Solitary Pulmonary Nodule/*microbiology ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Vincristine/adverse effects/therapeutic use