Intraoperative Contrast-Enhanced Ultrasonography (Io-CEUS) to Detect Missed Lung Nodules During Robot-Assisted Thoracoscopic Surgery.

Herein, we reported the use of Intraoperative-Contrast Enhanced Ultrasonography (Io-CEUS) during Robotic Assisted Thoracic Surgery (RATS) for identification of malignant lung nodule that was missed during previous operation. Pre-operative CT scan with 3D reconstruction defined the prompt position of the target lesion within S8 segment of right lower lobe and the anatomic landmarks as the distance from interlobar fissure and diaphragm. The lesion was then successfully detected by Io-CEUS. The different arterial enhancement observed during wash-in (hyperenhancement) and wash-out (hypo-enhancement) phases helped to differentiate the nodule from lung parenchyma. The lesion was resected by mechanical stapler and frozen section analysis diagnosed metastasis from colon carcinoma. Post-operative course was unremarkable; patient was discharged on post-operative day 3.