Intra-operative detection of a small lung nodule using methylene blue-is it time to revisit this technique?

Abstract

Background: Small lung nodules are difficult to localize on pre-operative imaging. Methylene blue has been previously reported as a safe and cost effective method for localization. Our case report describes this method to localize a small lesion prior to surgical resection. Case report: A 42 year old woman with an incidentally discovered 4mm right upper lung nodule was injected with methylene blue using CT guidance under local anesthesia. The lung nodule was visualized intra-operatively and resected by video-assisted thorascopic surgery. Final pathology demonstrated an atypical adenomatous hyperplasia. Discussion: Previous studies demonstrated that methylene blue can safely localize lung nodules. This study was described the successful use of this technique for a small lung nodule. Conclusions: Methylene blue contrast injection using CT guidance localizes small lung nodules with a minimum size of 4mm prior to resection. Future larger studies are needed to delineate this procedure for small lung nodules.