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Vascular and Interventional Radiology

E3289. Preoperative CT-Guided Lung Nodule Localization

Singh K,  Braun J. Allegheny General Hospital, Pittsburgh, PA

Address correspondence to K. Singh (

Background Information: Since the National Lung Screening Trial in 2011 established the use of low-dose CT in lung cancer screening, the number of lung nodules detected has increased dramatically. Many of these nodules are small and present diagnostic challenges even with dedicated CT, PET/CT, or image-guided percutaneous biopsy requiring the need for video-assisted thoracoscopic surgery (VATS). While VATS allows curative resection and accurate histologic diagnosis, pulmonary nodules that are not immediately subpleural can be difficult to identify intraoperatively. Various CT-guided techniques have been developed in aiding preoperative localization of these nodules. This exhibit reviews advantages, limitations, and complications of these techniques.

Educational Goals/Teaching Points: First we review indications and contraindications for preoperative localization. Next, procedure details such as equipment, patient preparation, methods, postprocedure care, and common complications are discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Techniques reviewed include metallic hook wires, coils, methylene blue, autologous blood, barium, 99mTc macroaggregates, lipiodol, cyanoacrylate glue, intraoperative ultrasound, and cone beam CT. We also discuss the combined use of these to improve localization. Common complications of pneumothorax, hemorrhage, hematoma, wire dislodgement, dye diffusion, and air embolism with tips to minimize their risk are discussed.

Conclusion: Multiple techniques are available for preoperative lung nodule localization. The exhibit will familiarize the audience with these techniques and their complications.