PMC9929662_01
CT and nuclear images. (A,B) CT and PET-CT image of right lower lobe lesion. (C,D) CT and PET-CT image of RUL lesion. CT, computed tomography; PET, positron emission tomography; RUL, right upper lobe.
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A positron emission tomography (PET)-scan was therefore performed which showed both identified nodules to be fluorodeoxyglucose (FDG)-avid, without mediastinal involvement or other signs of metastatic disease (see Figure 1).
Submucosal lesion with dotted vessel on the subcarina between apicoposterior and anterior subsegment of the LUL. LUL, left upper lobe.
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Repeated sampling using a forceps biopsy instrument was performed (see Figure 2).
CBCT and augmented fluoroscopy images. (A) Segmented lesion RUL with EWC at the lesion. (B) Segmented nodule in RLL with EWC in contact with nodule. (C) Augmented fluoroscopy image with in blue the segmented nodule of the RUL. Needle can be seen in the lesion. (D) Augmented fluoroscopy image with in blue the segmented nodule of the RLL. The pink dot is set at the distal tip of the EWC, so the CBCT image (taken in breath hold) can be correlated with the live augmented fluoroscopy image. Forceps is in contact with the lesion. CBCT, cone-beam computed tomography; RUL, right upper lobe; EWC, extended working catheter; RLL, right lower lobe.
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Lesion access was confirmed with rEBUS and CBCT (Figure 3). Navigation towards this lesion resulted in immediate access of the nodule and position confirmation was obtained by rEBUS and a new CBCT spin (Figure 3).