Percutaneous localization of small pulmonary metastases, enabling limited resection

An adolescent patient with Ewing's sarcoma, who had undergone three previous thoracotomies for pulmonary metastases, presented with two further left-sided pulmonary metastases, measuring 5 mm and 10 mm in diameter. Chemotherapeutic options were limited, and pulmonary irradiation was inadvisable because of compromised respiratory function. Surgical resection was the favored therapeutic option. A method of accurately localizing the small lesions was devised, using a percutaneous needling technique under computed tomography guidance and the injection of barium and methylene blue. This localization enabled resection of the lesions, with minimal excision and manipulation of the surrounding normal parenchyma. This technique is useful for removal of small impalpable metastases when other modalities of therapy are not appropriate.