Nasner Daniela, Mejía-Quiñones Valentina, Velásquez-Galvis Mauricio, Toro-Gutiérrez Juan Sebastián
Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.
Faculty of Health Sciences, School of Medicine, Universidad Icesi, Cali, Colombia.
Radiol Case Rep. 2023 Oct 12;18(12):4479-4484. doi: 10.1016/j.radcr.2023.09.047. eCollection 2023 Dec.
Physicians are facing a growing challenge in characterizing suspicious pulmonary lesions through biopsy. Video thoracoscopic surgery is crucial for conducting surgical biopsies of these nodules. However, accurately identifying small pulmonary nodules, tiny, subsolid, and deep ones, remains a significant challenge due to the absence of digital palpation. One proposed technique for localization involves using a harpoon, initially designed for mammary nodules but also applied to pulmonary nodules. In cases involving solitary pulmonary nodules, histologic characterization is often necessary also accurate descriptions through computed tomography and the patient's clinical and epidemiologic context allow for a presumptive diagnosis. In this case, during an abdominal CT scan, a 49-year-old female patient was serendipitously found to have a ground-glass infiltrate in the anteromedial segment of the lower lobe of her left lung. Despite presenting with normal lung auscultation on physical examination, the increasing prevalence of subsolid lung nodules, combined with the contemporary era of minimally invasive surgery, prompted the medical team to employ CT-guided harpoon marking for precise lesion localization. Subsequent pathology analysis confirmed the presence of lepidic pattern adenocarcinoma. This case underscores the efficacy of the CT-guided harpoon marking approach, which significantly enhances surgical precision. Such precision is paramount in formulating individualized treatment strategies and follow-up plans for patients with similar clinical presentations.
医生在通过活检对可疑肺部病变进行特征描述方面面临着日益严峻的挑战。电视胸腔镜手术对于对这些结节进行手术活检至关重要。然而，由于缺乏数字触诊，准确识别小的肺结节、微小的、亚实性的和深部的肺结节仍然是一项重大挑战。一种提出的定位技术涉及使用鱼叉，该鱼叉最初设计用于乳腺结节，但也应用于肺结节。在涉及孤立性肺结节的病例中，组织学特征描述通常也是必要的，通过计算机断层扫描以及患者的临床和流行病学背景进行准确描述有助于做出初步诊断。在本病例中，在一次腹部CT扫描时，一名49岁女性患者意外发现左肺下叶前内侧段有磨玻璃样浸润影。尽管体格检查时肺部听诊正常，但亚实性肺结节的患病率不断上升，再加上当代微创手术时代的背景，促使医疗团队采用CT引导下的鱼叉标记法进行精确的病变定位。随后的病理分析证实存在鳞屑样腺癌。该病例强调了CT引导下鱼叉标记法的有效性，该方法显著提高了手术精度。这种精度对于为具有类似临床表现的患者制定个体化治疗策略和随访计划至关重要。
