Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules.Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied.Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra- or postoperative mortality or morbidity was observed.Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.     

胸腔镜肺小结节切除术前微弹簧圈定位的临床应用研究

目的:研究孤立性肺结节(SPN)胸腔镜术前CT引导下双弹簧圈精准标记定位的应用价值。方法:回顾分析43例SPN胸腔镜术前定位病例资料，包括双弹簧圈组22例，Hook-wire定位组21例。统计双弹簧圈定位的术中、术后并发症，衔接期时间以及作楔形切除所用时间，并将两组结果进行对比分析。结果:两组病例定位均取得成功；双弹簧圈组的气胸发生率(9.0%)，肺出血发生率(9.0%)，胸痛发生率(9.0%)均低于Hook-wire组，其中肺出血发生率与Hook-wire组比较，差异有统计学意义(P＜0.01)；衔接时间双弹簧圈组（15.38±8.32）h长于Hook-wire组（4.21±3.29）h，差异有统计学意义（P＜0.05）；作楔形切除所用时间双弹簧圈组(21.01±7.14)min与Hook-wire组(18.22±5.18)min差异无统计学意义(P＞0.05)。结论:采用双微弹簧圈进行SPN胸腔镜手术前精准标记定位安全可靠、效果良好，与Hook-wire定位比较并发症发生率更低，并可获得更长的衔接期，具有较高的应用价值。     

Agminated fibroblastic connective tissue nevus in a 1‐year‐old boy

Fibroblastic connective tissue nevus (FCTN) is a benign cutaneous mesenchymal lesion characterized by proliferation of CD34‐positive fibroblastic/myofibroblastic spindle‐shaped cells. We report a case of agminated FCTN on the right lower abdomen of a 1‐year‐old boy.     

Deep Granuloma Annulare (Pseudorheumatoid Nodule) in Children: Clinicopathologic Study of 35 Cases

Deep granuloma annulare (DGA) is one of several lesions of skin and superficial soft tissues whose histologic character is a palisading granuloma with a small central focus of necrosis or necrobiosis. Unlike the other palisading necrobiotic lesions, DGA has a predilection for children in the first 5 to 6 years of life. A painless subcutaneous nodule(s) in the lower anterior tibial region or foot and the scalp, typically in the occiput, was the most common presenting feature in this study of 35 cases. Additional or recurrent lesions were reported in approximately 70% of cases with clinical follow-up. All lesions showed the presence of necrobiosis; however, one of the characteristic features was the multinodular character of the predominantly mononuclear cellular aggregates. The presence of vascular spaces at the periphery of the nodular profiles served as a clue to the diagnosis of DGA. The palisading arrangement of the mononuclear cells was evident only in those foci with central necrobiosis. A histiocytic disorder or fibrohistiocytic process was a common consideration in the differential diagnosis, especially in those cases with less apparent foci of necrosis. Palisading histiocytes with prominent eosinophilic cytoplasm and some nuclear atypism were problematic with regard to possible epithelioid sarcoma. Our study failed to identify any underlying or predisposing factors in the development of DGA. Despite the fact that DGA is a well-documented lesion in children, it occurs sufficiently infrequently that it is often not considered clinically when it presents as a subcutaneous mass or masses in a child. Its recognition by the pathologist is especially important as the occurrence of additional lesions in a high proportion of children can be anticipated without undue concern. Received June 16, 1997; accepted October 28, 1997.     

Detection and characterization of small hepatocellular carcinoma

Abstract   Early detection and characterization of small hepatocellular carcinoma (HCC) by imaging is possible with high confidence, and is important for the improvement of the prognosis of the patient with liver cirrhosis. In this lecture, screening of HCC and its characterization by imaging, with special reference to imaging features of human multi step hepato carcinogenesis will be discussed.     

应用最大似然法鉴别诊断周围型肺癌、肺错构瘤和结核球的初步研究

目的:探讨应用最大似然法鉴别周围性肺癌、肺错构瘤及结核球3种孤立性肺结节(SPN)的诊断价值。方法:对150例经临床和手术病理证实的SPN(周围性肺癌、肺错构瘤、结核球各50例)的HRCT影像学征象进行分类统计分析,运用最大似然判别法,将其各种征象转化为记分值,以数值的大小来判定肺结节所属的类型。结果:最大似然法对周围型肺癌、肺错构瘤及结核球的诊断正确率分别为86%、92%及90%,平均诊断正确率为89.3%,高于常规阅片法的82%,但两组间差异无统计学意义(χ2=2.434,P>0.05)。最能提示为肺癌的征象依次为空泡征、分叶征、支气管充气征和血管集束征;最能提示为肺错构瘤的征象依次为脂肪、边缘清楚及钙化;最能提示为结核球的征象依次为空洞、卫星灶、钙化及胸膜凹陷征。结论:最大似然法对常见SPN的鉴别诊断正确率有所提高,是一种辅助影像学诊断的有价值的方法。     

螺旋CT动态增强扫描对孤立性肺结节定性诊断的价值

目的:分析良恶性孤立性肺结节(SPN)的动态强化特点,探讨动态SCT增强扫描对SPN定性诊断的价值。方法:对50例SPN患者进行螺旋CT同层动态增强扫描,对比剂总量100ml,注射流率3ml/s,延迟15s开始扫描,至180s结束,测量结节中心增强前后的CT值,分析最大强化值及时间-密度曲线(TAC),全部病例经手术病理证实。结果:肺炎性结节及恶性结节均显著强化,肺炎性结节强化峰值的时间较肺癌结节延迟。恶性结节的TAC表现为陡峭的上升支后有一较长的平台期,炎性结节的TAC表现为上升支平缓,部分见降支。结核球等其它良性SPN无明显强化。结论:动态SCT增强扫描对SPN定性诊断有较高价值。SPN的强化峰值及TAC形态有助于良、恶性病变的鉴别诊断。     

Solitary necrotic nodule of the liver: A riddle that is difficult to answer

Solitary necrotic nodule of the liver is an unusual lesion that is often an incidental finding on abdominal imaging, intraoperative examination, or post mortem. Most reported cases of solitary necrotic nodule have been in males, and over three quarters of these lesions have occurred in the right lobe of the liver. Pathologically, solitary necrotic nodule is a benign lesion characterized by a completely necrotic core that is often partly calcified, surrounded by a dense hyalinized fibrous capsule containing elastin fibres. The ultrasound appearance of solitary necrotic nodule is usually of a “target” lesion with a hyperechoic center, while on CT scan they appear as non-enhancing hypodense lesions that are typical of metastatic adenocarcinoma or peripheral cholangiocarcinoma. The impression of malignancy is further enforced with the finding of necrotic cellular material on biopsy and the macroscopically hard and “gritty” nature of the nodules. Currently, permanent histopathology of solitary necrotic nodules is the only accurate method of diagnosis. However, solitary necrotic nodules are usually of a bilobed or lobulated shape that is unusual for malignant liver lesions, and they often lie in close proximity to hepatic inflow structures. Solitary necrotic nodule should be suspected in liver lesions with this configuration, location, and on a biopsy showing a large amount of necrosis.