Pulmonary nodules in children have variable etiologies, and surgery is often required for diagnostic or therapeutic purposes. Thoracoscopic excision is a widely accepted technique, however, subpleural and sub-centimeter nodules can be difficult to visualize. Various CT-guided localization techniques have been described, though there is minimal published pediatric data regarding the use of microcoils. We hypothesize that microcoil localization facilitates thoracoscopic resection of pulmonary nodules in children.
A multi-institutional retrospective review of children who underwent preoperative CT-guided localization of lung nodules was conducted from 2012-2019. A combination of methylene blue dye, wires, and microcoils were utilized for CT-guided localization. When microcoils were utilized, they were identified under fluoroscopic guidance, and then resected, with fluoroscopy confirming coil removal.
Eighteen patients (mean age 13 years, range 2-21 years) underwent thoracoscopic resection of 24 preoperatively localized pulmonary nodules. Mean size and depth of the lesions were 5.5 mm and 10 mm, respectively. Twenty-three of twenty-four nodules were localized preoperatively; eighteen (75%) by microcoil placement alone, four (17%) by a combination of microcoil and wire placement, and two (8%) with wire placement alone. Methylene blue dye was also utilized for fourteen nodules (58%), twelve of which were localized with microcoils. Wire localization was not a durable technique, as 3 of 5 wires became dislodged upon lung isolation. Microcoil placement was successful 95% of the time and assisted in lesion localization in 88% of cases. Median postoperative hospitalization was three days, and there were no major complications during any of the procedures.
Preoperative CT-guided localization with microcoils is an effective technique to facilitate fluoroscopic-guided wedge resection of pulmonary nodules in children. This technique avoids the pitfall of wire dislodgement and can provide a consistent approach to localizing and resecting sub-centimeter, subpleural nodules.