Correct!
5. Video-assisted thoracoscopic surgical lung biopsy

Repeating the percutaneous transthoracic needle biopsy is not “wrong,” but the imaging during this procedure (Figure 7) shows that the needle was appropriately placed, yet the results were nondiagnostic, suggesting a low likelihood that a repeat procedure would be successful. For this reason, a definitive procedure- video-assisted surgical lung biopsy- is indicated. The peripheral location of the nodule makes it relatively unsuitable for bronchoscopic evaluation. Cryobiopsy is generally reserved for patients with diffuse lung diseases, not solitary pulmonary nodule tissue sampling. Intercostal arteriography is typically employed to control bleeding, commonly for patients with traumatic chest wall injury or hemothorax, and neither are considerations for this patient.

The patient underwent right-sided video- assisted thoracoscopic surgical lung biopsy. During the procedure the surgeon could visualize right-sided pleural nodularity and sampling of the right-sided pleural in the upper, anterior middle, and right lower chest was conducted, and the nodule was resected. Histopathological analysis of the nodule and all of the sampled pleura showed epithelioid hemangioendothelioma.

The patient was treated with several cycles of paclitaxel/gemcitabine as well as pazopanib following right pleurectomy, decortication, diaphragmatic resection and reconstruction, with liver resection also given that disease extended across the diaphragm from the right-sided pleura into the liver. Despite this therapy, her disease subsequently progressed and she died about 2 years after her right upper lobe lesion was discovered.

Diagnosis: Pulmonary epithelioid hemangioendothelioma with pleural metastatic disease

References

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