Abstract
With advances in high-resolution computed tomography (CT), small, sub-centimeter pulmonary nodules frequently require resection of the lesion for diagnosis and treatment. Preoperative localization of pulmonary nodules is sometimes necessary when the target nodule is too small or too far from the pleural surface to be detected intraoperatively by inspection or palpitation by surgeons. We marked small lesions with an injecting dye by CT fluoroscopy for the preoperative localization of metastatic pulmonary lesions of hepatoblastoma and combined this procedure with intraoperative indocyanine green (ICG) fluorescent imaging to identify small viable lesions. We herein report three cases of resection of minute pulmonary nodules preoperatively localized by CT-guided dye marking. Case 1: A 4-year-old boy with hepatoblastoma in the right lobe (PRETEXT II) underwent right hepatectomy. After chemotherapy, a pulmonary metastatic nodule was observed. Pulmonary wedge resection was performed via video-assisted thoracoscopic surgery on the basis of preoperative CT-guided dye marking. Case 2: A 1-year-old male infant with hepatoblastoma (PRETEXT III, V, R, M) was scheduled to undergo liver transplantation. To remove two extrahepatic metastatic lesions before transplantation, pulmonary wedge resection of the right lung was performed on the basis of preoperative CT-guided marking combined with ICG fluorescent imaging. Case 3: A 3-year-old boy with hepatoblastoma (PRETEXT III, E, R, M) in the left lobe underwent left hepatectomy. After postoperative chemotherapy, seven residual nodules in the lungs were resected on the basis of CT-guided marking and ICG fluorescent imaging findings. CT-guided marking, especially combined with ICG fluorescent imaging, is feasible and useful for identifying small metastatic pulmonary lesions of hepatoblastoma.
