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Diagnosis of 15mm Posterior RUL Peripheral Nodule

Dr. Joseph Seaman

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Fig 1. CT image showing peripheral RUL lesion
Fig 1. CT image showing peripheral RUL lesion

Background

The patient is a 74 year old male with a 50 pack-year smoking history who was referred 18 months prior for an incidental 13mm RUL nodule. A work-up at that time showed low level PET activity. A navigation bronchoscopy was performed using legacy technology and was non-diagnostic. The patient was then referred for transthoracic needle biopsy and that procedure was also non-diagnostic. The nodule slowly grew to 15mm over the course of the next 18 months, and so a MONARCH® Bronchoscopy was scheduled to diagnose this nodule.

Procedure

PLANNING/PROCEDURE SUMMARY

The nodule was located in the posterior RUL with no bronchus sign visible on CT. There appeared to be two blood vessels on either side of the nodule on axial CT (Fig.1). The navigation was difficult to optimize access to the nodule. The nodule was completely eccentric on R-EBUS on the initial approach. After using a biopsy needle to traverse the bronchial wall and access the lung parenchyma (Fig.2), the mini probe was passed through the bronchial wall and a concentric R-EBUS signal was visualized (Fig.3).

Fig 3. Concentric radial EBUS view
Fig 3. Concentric radial EBUS view

"The value of VISION the MONARCH® Platform provided me was something that lacked for two previously non-diagnostic procedures."

Conclusions

Using the MONARCH® Platform, I was able to visualize and plan my approach to access the target lesion. Once an optimal approach was created, we used the needle to traverse the bronchial wall and access the lung parenchyma. This approach allowed for access to the lesion and provided a diagnosis of adenocarcinoma. The value of VISION the MONARCH® allowed me was something that lacked for the two previously non-diagnostic procedures. With this diagnosis the patient will now be able to discuss personalized treatment options, instead of “watch and wait” as his nodule potentially continued to increase in size.

Dr Joseph Seaman

About Dr. Joseph Seaman

Dr. Seaman is an Interventional Pulmonologist at Sarasota Memorial Hospital in Sarasota, FL.

Indications for Use: The Monarch™ Platform and its accessories are intended to provide bronchoscopic visualization of and access to patient airways for diagnostic and therapeutic procedures.

Important Safety Statement: Complications from bronchoscopy are rare and most often minor, but if they occur, may include breathing difficulty, vocal cord spasm, hoarseness, slight fever, vomiting, dizziness, bronchial spasm, infection, low blood oxygen, bleeding from biopsied site, or an allergic reaction to medications. It is uncommon for patients to experience other more serious complications (for example, collapsed lung, respiratory failure, heart attack and/or cardiac arrhythmia).

This document reflects the techniques, approaches and opinions of the individual physician. This Auris sponsored document is not intended to be used as a training guide. Other physicians may employ different techniques. The steps demonstrated may not be the complete steps of the procedure. Individual physician preference and experience, as well as patient needs, may dictate variation in procedure steps. Before using any medical device, review all relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s).

Dr Joseph Seaman is compensated by and writing on behalf of Auris Health and must present information in accordance with applicable FDA requirements.