الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The identification of the peripherally settled pulmonic nodules has remained diagnostic quandary. Within setting of recent guidelines for carcinoma screening
Spherical lesion with diameter of 30 millimeters or less and at least two-thirds of its edges contained by lung parenchyma is referred to as solitary pulmonary nodule.
Specific clinical options influence the probability of benignity or malignancy, & in conjunction with imaging characteristics of lesion will affect each diagnostic approach & selection of therapeutic choices.
Pulmonary nodules with diffuse pattern and sizes between few millimeters and one centimeter in diameter may be signs of interstitial or airspace disease. Main distribution of nodules can indicate the underlying disease.
For lesions with high likelihood of developing into cancer, surgical excision is advised; for lesions with lower likelihood, radiological follow-up is preferred. Further tests are advised for individuals with intermediate risk lesions; these tests must be chosen depending on nodule’s size, location, proximity to patent airway, studied case’s personal risk of complications, & level of available knowledge. For nodules close to chest wall or for deeper lesions, CT scan-guided transthoracic needle aspiration is typically chosen, if fissures do not need to be traversed & there is no surrounding emphysema.
Video assisted thoracic surgery (VATS) can perform those previously mentioned indications; nevertheless, it is invasive procedure requiring general anesthesia, two surgical openings or thoracotomy and selective double lumen intubation. It entails a long duration of hospitalization and is contraindicated in very ill patients
Pulmonologists have utilized forceps lung biopsy throughout thoracoscopy under local anesthesia for several years, & it is frequently referred to as essential method of medical thoracoscopy.
Thoracoscopic lung biopsy can be done using endoscopic stapler or using coagulating forceps. Coagulating forceps set at sixty to one hundred watt may coagulate & seal cut surface.
Most common application of ultrasound is as imaging aid for pleural or pleural space treatments. To access pleural fluid collections or to biopsy peripheral lung & pleural lesions, ultrasound is frequently used.
Thoracic interventional radiology frequently uses the transthoracic needle biopsy technique. Precise cytologic or histologic diagnosis may be made using TTNB safely & effectively.
In the present study fifty patients with peripheral parenchymal lung lesions with chest wall contact which are undiagnosed by noninvasive testing were recruited from the Alexandria main university hospital, chest diseases department. They were randomly allocated into three equal groups:-
- group A: twenty five patients underwent US-guided transthoracic core needle biopsies
- group B: twenty five thoracoscopic lung biopsies using coagulating forceps.
Studied cases with any of following results were excluded:
Coagulation deficit (prothrombin level <fifty percent or platelet count <70,000 cells.mm), 2-severe respiratory insufficiency (arterial carbon dioxide tension >60 mmHg) 3-inability to oxygenate studied case throughout process 4-mechanical ventilation 5- radiological signs suggesting significant pleural adhesions or major bullous degeneration of lung.