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

Purpose: To evaluate the effectiveness of fluoroscopy-guided barium marking for localization of small peripheral pulmonary lesions before video-assisted thoracic surgery (VATS) resection. Material & methods: Twenty-one patients with peripheral pulmonary lesions 15mm 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. Results: The average instilled volume of barium was 0.42±0.07ml. On CT scans, barium spots were superimposed on the target lesions in 19 of the 21 patients and were only 6–7mm 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. Conclusion: Fluoroscopy-guided barium marking is a safe, convenient, and reliable method for localization of small pulmonary lesions before VATS resection.