Pediatric Radiology

, Volume 48, Issue 5, pp 626–631 | Cite as

CT-guided localization of pulmonary nodules in children prior to video-assisted thoracoscopic surgical resection utilizing a combination of two previously described techniques

  • Janice D. McDaniel
  • John M. Racadio
  • Manish N. Patel
  • Neil D. Johnson
  • Kamlesh Kukreja
Original Article



Pulmonary nodules in pediatric oncology patients can present a diagnostic and treatment dilemma. Imaging findings are often nonspecific and tissue diagnosis may be required for appropriate treatment. The smaller subpleural nodules may not be visualized and cannot be palpated during video-assisted thoracoscopic surgical (VATS) resection. Preoperative localization has been beneficial in obtaining an adequate pathological specimen.


This study presents experience in a large pediatric hospital using CT-guided preoperative localization of pulmonary nodules combining two previously utilized techniques, hook wire and methylene blue blood patch localization.

Materials and methods

A search of the electronic medical record utilizing a medical record search application was performed to identify all patients who underwent preoperative lung nodule localization during a 12.5-year period (July 1999 through January 2012). A retrospective chart review of these patients was then performed. Pre- and postoperative imaging, interventional radiology procedural images and reports, surgical reports, and pathology reports were obtained and evaluated.


Thirty-five patients, with 40 nodules, who underwent preoperative CT-guided lung nodule localization were identified. Patients ranged in age from 8 months to 21 years. The pulmonary nodules ranged in size from 1.4 mm to 18 mm. Twelve nodules were localized using a Kopans breast lesion localization needle with hook wire, 4 were localized using a methylene blue blood patch, and 24 were localized using the combination of these two techniques. The technical success rate of all procedures was 100%. A pathological diagnosis was determined in 39 patients (97.5%). There were 6 (15.0%) minor complications and no major complications.


CT-guided lung nodule localization using the combined techniques of methylene blue blood patch and hook wire is safe, technically feasible and successful in children. Using this combination of techniques will consistently yield a pathological diagnosis, is currently the preferred technique at our tertiary pediatric hospital and could be considered the new best practice.


Children Localization Lung nodule Lungs Oncology Video-assisted thoracoscopic surgery 



Sincere gratitude to the staff of the Rebecca D Considine Research Institute at Akron Children's Hospital, particularly Mira Brown, MS GStat, and Jennifer Clark, MA for their support and assistance.

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Partrick DA, Bensard DD, Teitelbaum DH et al (2002) Successful thoracoscopic lung biopsy in children utilizing preoperative CT-guided localization. J Pediatr Surg 37:970–973CrossRefPubMedGoogle Scholar
  2. 2.
    McConnell PI, Feola GP, Meyers RL (2002) Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules. J Pediatr Surg 37:1729–1731CrossRefPubMedGoogle Scholar
  3. 3.
    Ambrogi MC, Melfi F, Zirafa C et al (2012) Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules. Surg Endosc 26:914–919CrossRefPubMedGoogle Scholar
  4. 4.
    Watanabe K, Nomori H, Ohtsuka T et al (2006) Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopic-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg 132:320–342CrossRefPubMedGoogle Scholar
  5. 5.
    Nakashima S, Watanabe A, Obama T et al (2010) Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastasis pulmonary nodules. Ann Thorac Surg 89:212–219CrossRefPubMedGoogle Scholar
  6. 6.
    Heran MKS, Sangha BS, Mayo JR et al (2011) Lung nodules in children: video-assisted thoracoscopic surgical resection after computed tomography-guided localization using microcoil. J Pediatr Surg 46:1292–1297CrossRefPubMedGoogle Scholar
  7. 7.
    Gow KW, Chen MK (2010) American Pediatric Surgical Association New Technology Committee review on video-assisted thoracoscopic surgery for childhood cancer. J Pediatr Surg 45:2227–2233CrossRefPubMedGoogle Scholar
  8. 8.
    Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology Clinical Practice Guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefPubMedGoogle Scholar
  9. 9.
    Sortini D, Feo C, Maravegias K et al (2006) Intrathoracic localization techniques: review of literature. Surg Endosc 20:1341–1347CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Janice D. McDaniel
    • 1
  • John M. Racadio
    • 2
  • Manish N. Patel
    • 2
  • Neil D. Johnson
    • 2
  • Kamlesh Kukreja
    • 3
  1. 1.Department of Radiology, Division of Interventional RadiologyAkron Children’s HospitalAkronUSA
  2. 2.Department of Radiology, Division of Interventional RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of Radiology, Division of Interventional RadiologyTexas Children’s HospitalHoustonUSA

Personalised recommendations