Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules

J Thorac Cardiovasc Surg. 2006 Aug;132(2):320-4. doi: 10.1016/j.jtcvs.2006.04.012.


Objective: Several techniques have been reported for the localization of small pulmonary nodules in thoracoscopic resection. In the present study we examined the usefulness and complications of computed tomography-guided lipiodol marking for thoracoscopic resection in our experience of 174 nodules.

Methods: Computed tomography-guided lipiodol marking was performed on 174 nodules less than 30 mm in size. Of these nodules, 45 showed ground-glass opacity images and 129 showed solid images on computed tomography. The mean size of the nodules was 10 +/- 6 mm (range, 2-30 mm), and their mean depth from the pleural surface was 10 +/- 7 mm (range, 0-30 mm). One to 7 days before thoracoscopy, all of the nodules were marked with 0.4 to 0.5 mL of lipiodol by using computed tomography. The marked nodules were grasped with a ring-shaped forceps during fluoroscopy and resected by means of thoracoscopy.

Results: All the nodules could be marked and localized by means of fluoroscopy as a clear spot during thoracoscopic surgery. Complications of the marking were chest pain requiring analgesia in 16 (11%) patients, hemosputum in 11 (6%) patients, pneumothorax in 30 (17%) patients, and hemopneumothorax in 1 (0.6%) patient. Eleven (6%) patients with pneumothorax required drainage, and the patient with hemopneumothorax required an emergency operation. No other complications were observed.

Conclusion: Lipiodol marking is a useful, safe, and inexpensive procedure for localizing ground-glass opacity lesions, small pulmonary nodules, or both for thoracoscopic resection.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media* / administration & dosage
  • Contrast Media* / adverse effects
  • Fluoroscopy
  • Humans
  • Iodized Oil* / administration & dosage
  • Iodized Oil* / adverse effects
  • Lung Neoplasms / surgery*
  • Middle Aged
  • Solitary Pulmonary Nodule / surgery*
  • Tattooing / methods*
  • Thoracoscopy*
  • Tomography, X-Ray Computed


  • Contrast Media
  • Iodized Oil