Fluoroscopy-guided barium marking for localizing small pulmonary lesions before video-assisted thoracic surgery

To evaluate the effectiveness of fluoroscopy-guided barium marking for localization of small peripheral pulmonary lesions before video-assisted thoracic surgery (VATS) resection.

Twenty-one patients with peripheral pulmonary lesions 15 mm or less in diameter who were scheduled to undergo VATS resection were studied. A catheter was inserted bronchoscopically into the target segment and guided to a presumed lesion. The tip of the catheter was confirmed fluoroscopically to be at the exact spot determined beforehand. A 50% (weight/volume) barium sulfate suspension was instilled into the bronchus through the catheter, and the site of barium marking was ascertained by CT scanning.

The average instilled volume of barium was 0.42+/-0.07 ml. On CT scans, barium spots were superimposed on the target lesions in 19 of the 21 patients and were only 6-7 mm from the lesions in the other 2. Barium was well preserved in all patients at the time of VATS resection. A mild cough persisted for about 1 week in one patient, but the other patients had no specific complications.

Fluoroscopy-guided barium marking is a safe, convenient, and reliable method for localization of small pulmonary lesions before VATS resection.