PMC5491757_01
A. CT chest at the level of the right lower lobe lesion. Arrow points to lesion. B. Bronchoscopic view of right lower lobe lesion. C. CT chest at the level of the left lower lobe lesion. Arrow points to lesion, visible as subtle soft tissue density in bronchus. D. Bronchoscopic view of left lower lobe lesion.
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He had originally undergone chest CT 3 months prior for progressive dyspnea on exertion; this showed multiple pulmonary nodules. 3-month follow-up CT scan demonstrated stability of these nodules; however, there was progressive soft tissue thickening at the right lower lobe bronchus concerning for malignancy (See Fig. 1). Fiberoptic bronchoscopy revealed a circumferential, sessile, verrucous lesion at the right lower lobe bronchus with narrowing of the bronchial lumen (See Fig. 1).
A. EBUS view of fiducial marker placement in right lower lobe lesion. Arrow points to marker. B. EBUS view of fiducial marker placement in left lower lobe lesion. Arrow points to marker.
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The needle was deployed under real-time ultrasonographic guidance, leaving sufficient space within the tumor for the fiducial marker. The stylet was then advanced to force the coil into the tumor (See Fig. 2).
A. 3-view CT simulation of right lower lobe. Arrows point to fiducial marker in each view. B. 3-view CT simulation of left lower lobe. Arrows point to fiducial marker in each view.
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CT scan performed at simulation demonstrated satisfactory position of the fiducial markers (See Fig. 3).