Diagnostic Approach to Pulmonary Nodules in the Postpneumonectomy Patient

P CHALLENGE The postpneumonectomy patient with an indeterminate pulmonary nodule in the contralateral lung represents a formidable diagnostic and therapeutic challenge. The diagnosis of suspicious peripheral lung nodules is performed most commonly by computed tomography (CT)–guided transthoracic needle aspiration (TTNA). Depending on the size and location, the diagnostic accuracy of TTNA ranges from 65%-96%.1 The TTNA-associated risk of pneumothorax, particularly in patients with emphysema, is 21%-40%, depending on the number of needle passes and the experience of the operator.2,3 Many interventional radiologists consider a previous pneumonectomy as a contraindication to TTNA because of the significant risk of pneumothorax. In one published report, TTNA in postpeumonectomy patients was performed with a thoracic surgeon directly standing by for potential emergent tube thoracostomy.4 We propose a safe diagnostic technique with therapeutic potential for postpeumonectomy patients with indeterminate pulmonary nodules.