Lung Laceration Caused by Short Hookwire Placement Before Video-Assisted Thoracoscopic Surgery
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LETTER TO THE EDITOR
Lung Laceration Caused by Short Hookwire Placement Before Video-Assisted Thoracoscopic Surgery Kazuaki Munetomo1 • Yusuke Matsui1 • Toshihiro Iguchi1 • Takao Hiraki1 Hiromasa Yamamoto2 • Shinichi Toyooka2 • Susumu Kanazawa1
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Received: 3 September 2020 / Accepted: 18 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
To the editor, Computed tomography (CT)-guided placement of a short hookwire and suture marking system (Guiding-Marker System; Hakko, Tokyo, Japan) is one of the useful methods for localizing lung nodules during video-assisted thoracoscopic surgery (VATS), especially when they are small or far from the pleura [1]. Although pneumothorax frequently occurs, most of them are minor and require no intervention [1]. Herein, we report two cases of lung laceration with massive pneumothorax caused by the placement of this system. The first case was a male in his eighties with a history of bilateral lung adenocarcinoma resection and a 90 packyears smoking. The short hookwire placement was performed before VATS resection of another 12-mm groundglass nodule in the right lower lobe. With the patient’s prone position and inhalation breath hold, a 21-gauge introducer needle was inserted into the lung via the narrow pathway between scapula and ribs under CT fluoroscopy guidance. Soon after the patient started breathing, a massive pneumothorax occurred, and the needle was removed. Because CT images showed further progression of the pneumothorax, a chest tube was placed immediately. CT scan after the drainage showed an improved pneumothorax and an 8-mm-long linear low-density area along the needle & Yusuke Matsui [email protected] 1
Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
2
Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
pathway, suggesting lung laceration (Fig. 1A). Thereafter, the hookwire was placed via another route. The lung laceration was thoracoscopically confirmed during VATS (Fig. 1B). The resected specimen included a lacerated part (Fig. 1C) as well as a lung adenocarcinoma. The patient was discharged on postoperative day 8 without any sequelae. The second case was a female in her fifties with a history of uterine leiomyosarcoma and a 45 pack-years smoking. The short hookwire placement was performed before VATS resection of a 5-mm lung nodule in the left lower lobe, suspected as a metastasis. The hookwire placement was performed with the patients’ prone position in the same way as in case 1. Chest CT performed immediately after the hookwire placement showed massive pneumothorax and a 25-mm-long lung laceration (Fig. 2). The pneumothorax improved by chest drainage, and VATS was successfully performed 2 h later. She was discharged on postoperative day 7 without any sequelae. Lung laceration can be caused by percutaneous transth
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