Methylene blue localizations of pulmonary nodules under CT-guidance: a new procedure used before thoracoscopic resections.

With the expending use of video-assisted thoracoscopy for a wide range of indications, we present our experience of CT-guided localizations of pulmonary nodules with methylene blue injections before their thoracoscopic resections. This technique was developed for deep non-palpable nodules of small size. Forty seven nodules in 44 patients were preoperatively localized under CT guidance and marked with methylene blue injections. The localizations under CT guidance of the 47 nodules were successful in all cases. The surgeon confirmed accurate localization of 46 nodules. In one case, the injected methylene blue could not be identified during thoracoscopy. Complications of this technique included 7 cases of asymptomatic pneumothorax, 5 cases of local and asymptomatic pulmonary hemorrhage, and 2 cases of fits of coughing. Because of this technique, 46 diagnostic thoracotomies could be avoided. CT guided localization with methylene blue injection is a simple and rapid technique enabling good thoracoscopic surgery results.