A new safe and stable spiral wire needle for thoracoscopic resection of lung nodules

Background: To show the safety and stability of a spiral wire needle (Somatex; Rietzneuendorf, Germany) in the detection and subsequent thoracoscopic resection of subpleural and/or small nodules of the lung. Methods: Under local anesthesia and CT control, 13 patients underwent the positioning of a spiral wire needle into the lung, with the spiral located close to or inside the nodule to be resected. Then the patients underwent video-assisted thoracoscopic surgery resection of the nodules with only two thoracoscopic accesses. Results: All the nodules were identified due to the precise location of the spiral wire needle. The presence of a stable spiral wire inside the parenchyma has allowed us to put under tension the overlying parenchyma, which had previously been excluded from ventilation. The external traction on the needle facilitates the detection of the nodule and simplifies thoracoscopic resection with a stapler. With this new tool, we have always reached an adequate diagnosis and observed no cases of dislodgment of the needle during the traction maneuvers, nor cases of conversion from thoracoscopy to thoracotomy. Conclusions: Although our initial experience is limited, the use of this spiral wire needle has been shown to be extremely advantageous in identifying subpleural and/or small nodules of the lung, even sparing the classic third thoracoscopic access for their resection. The presence of a wire needle with a spiral terminal portion (which is placed firmly inside the lung parenchyma) is very useful for the thoracoscopic resection of pulmonary nodules

Two-year survival after multiple bilateral lung metastasectomies for cranial meningioma

The lung represents a common site of metastases from extrathoracic malignancies, and several studies have strengthened the evidence that complete resection of pulmonary metastases is a useful therapeutic treatment for prolonged survival in selected patients. However, fewer data are available in the literature regarding the role of lung metastasectomy in rare malignancy. We present a case of extensive bilateral lung metastases due to recurrent cranial meningioma, which was successfully treated by aggressive, staged metastasectomies

Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab

Objectives We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case. Methods Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values < 0.05) Results Totally, 337 patients suspected of COVID-19 underwent CT and nasopharyngeal swabs in March 2020. Eighty-seven out of 337 patients had a negative first RT-PCR result; of these, 68 repeated RT-PCR testing and were included in the study. The first RT-PCR test showed SE 0, SP = 100%, PPV = NaN, NPV = 70%, AUC = 50%, and CT showed SE = 70% SP = 79%, PPV = 86%, NPV = 76%, AUC = 75%. The most relevant CT variables were ground glass opacity more than 50% and peripheral and/or perihilar distribution. Discussion Negative RT-PCR test but positive CT features should be highly suggestive of COVID-19 in a cluster or community transmission scenarios, and the second RT-PCR test should be promptly requested to confirm the final diagnosis