Fluoroscopy-guided Barium Marking for Localizing Small Pulmonary Lesions Before Video-assisted Thoracoscopic Surgery

DOI 2 Citations 29 References
  • Yamada Takahiro
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Koyama Yasunori
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Masui Asami
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Tamiya Nobuyo
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Hosogi Shigekuni
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Hiramatsu Atsushi
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Kohno Yoshihito
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Ueda Mikio
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Arimoto Taichiro
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine
  • Iwasaki Yoshinobu
    Department of Respiratory Disease, Kyoto Prefectural University of Medicine

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Other Title
  • 肺小型病変に対する気管支鏡下バリウムマーキングの有効性と安全性の検討

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Background and Purpose. Small pulmonary lesions not previously seen on chest radiographs will likely be detected with increasing frequency because of the spread of CT screening. For the diagnosis and treatment of such lesions, we frequently perform resection by video-assisted thoracoscopic surgery (VATS). We performed fluoroscopy-guided barium marking for localization of small peripheral pulmonary lesions before VATS resection, and examined its reliability, safety, and usefulness. Methods. We studied 46 patients with peripheral pulmonary lesions 20mm or less in diameter who were scheduled to undergo VATS resection. The average diameter of the lesions was 10.2±0.5mm (mean±standard error), and the average distance from the pleural surface was 10.1±0.8mm. The optimal site for the catheter tip was decided on chest radiographs using CT scans for reference beforehand, and a catheter was inserted bronchoscopically into the target segment and guided to the presumed lesion. A 50% (weight/volume) barium sulfate suspension was instilled into the bronchus through the catheter, and the site of barium marking was checked by CT scanning. Results. The average instilled volume of barium was 0.36±0.03ml. On CT scans, barium spots were superimposed on the target lesions in 35 of the 46 patients and were only 15mm from the lesions in the other patients. Barium was well recognized in all patients at the time of VATS resection, and we could confirm the diagnosis in all patients. A mild cough persisted for about 1 week in 1 patient, but the other patients had no specific complications. Conclusion. Fluoroscopy-guided barium marking is a safe, convenient, and reliable method for localization of small pulmonary lesions before VATS resection.

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