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Case Reports
. 2025 Sep 18;15(18):2374.
doi: 10.3390/diagnostics15182374.

First Experiences with Ultrasound-Guided Transthoracic Needle Biopsy of Small Pulmonary Nodules Using One-Lung Flooding: A Brief Report

Thomas Lesser  1 , Christian König  2 , Seyed Masoud Mireskandari  3 , Uwe Will  4 , Frank Wolfram  1 , Julia Gohlke  1
Affiliations
Case Reports

First Experiences with Ultrasound-Guided Transthoracic Needle Biopsy of Small Pulmonary Nodules Using One-Lung Flooding: A Brief Report

Thomas Lesser et al. Diagnostics (Basel). .

Abstract

Introduction: Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. Methods: In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. Results: In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. Conclusions: USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort.

Keywords: indeterminate small pulmonary nodules; one-lung flooding; ultrasound-guided transthoracic core needle biopsy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) CT scan showing a small pulmonary nodule adjacent to a vessel within the middle lobe. (B) Transthoracic ultrasound of the right lung under OLF revealing a smoothly marginated hypoechoic nodule adjacent to a vessel (arrow). (C) Contrast-enhanced ultrasound of the flooded lung showing a hypoechoic nodule (dashed circle) without contrast enhancement. (D) Free-hand ultrasound-guided biopsy using a T-shaped intraoperative transducer (bK medical GmbH, Quickborn, Germany). (E) Transthoracic lung ultrasound under OLF with a core biopsy needle (arrows) inserted into the nodule (dashed circle). (F) Histological image of the core biopsy showing a complete necrotic area above and vital normal lung tissue below (hematoxylin–eosin stain).
Figure 2
Figure 2
Lung function values of case 2 before and 44 h after USgTTcNB under OLF.
See this image and copyright information in PMC

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