Song Xu, Li Jie, Wang Di
Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of sciences, Ningbo, China.
Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China.
J Cardiothorac Surg. 2020 Apr 19;15(1):63. doi: 10.1186/s13019-020-01105-2.
CT-guided hook wire has been recognized to be a safe and effective percutaneous localizer to identify small pulmonary lesions with ground-glass opacity (GGO) component, while several association complications including pneumothorax, hemothorax, intrapulmonary hemorrhaging, aeroembolism and dislodgement have been reproted. However, sliding into pulmonary artery is an extremly rare comlication of hook wire localization.
A 61-year-old male suffered from multiple pulmonary nodules received right upper lobectomy and right lower lobe wedge resection by video-assisted thoracic surgery (VATS) 3 months ago. Since it might be difficult to identify the ground-glass opacity located in the right lower lobe, a CT-guided hook wire was placed before surgery. During the operation, the hook wire unexpectedly slided into left upper lobe pulmonary artery. With the help of vascular surgery department, the hook wire was extracted by interventional therapy under digital substraction angiography (DSA). The patient was eventually recovered and discharged.
During localization procedure, the tip of hook wire should be far from pulmonary vessels. At the beginning of the operation, the hook wire might as well be removed first. Even if the hook wire was still required to be in the pulmonary parenchyma, it should be fixed to the pleural by a titanic clip or a hemolock clip.
CT引导下钩丝已被公认为是一种安全有效的经皮定位器，用于识别具有磨玻璃密度（GGO）成分的小肺部病变，不过已报道了包括气胸、血胸、肺内出血、空气栓塞和移位在内的几种相关并发症。然而，钩丝滑入肺动脉是一种极其罕见的钩丝定位并发症。
一名61岁男性3个月前因多发肺结节接受了电视辅助胸腔镜手术（VATS）下的右上叶切除术和右下叶楔形切除术。由于可能难以识别位于右下叶的磨玻璃密度影，术前放置了CT引导下钩丝。手术过程中，钩丝意外滑入左上叶肺动脉。在血管外科的帮助下，通过数字减影血管造影（DSA）下的介入治疗取出了钩丝。患者最终康复出院。
在定位过程中，钩丝尖端应远离肺血管。手术开始时，不妨先取出钩丝。即使仍需要钩丝留在肺实质内，也应用钛夹或血管夹将其固定在胸膜上。
