Video-assisted thoracic surgical (VATS) biopsy as a technique for differential diagnosis of indeterminate small pulmonary nodules

The authors experienced two cases of multiple pulmonary tuberculomas, which were suspected of metastatic lung tumors. First patient was a 63-years-old male, who was found to have multiple pulmonary nodular shadows on his check up chest X-ray film, suspected of pulmonary metastases of rectal cancer. VATS biopsy, performed for one of nodules revealed that it was caseating granuloma, suggestive of pulmonary tuberculosis. Second patient was a 55-years-old female with rheumatoid arthritis and a chest X-ray film showed multiple pulmonary nodules, which were thought to be metastatic lung tumor from unknown origin. VATS biopsy for a subpleural nodule showed epitheloid granuloma with caseous necrosis of lung, indicating pulmonary tuberculosis. VATS biopsy is, therefore, an useful technique for differential diagnosis of small pulmonary nodules of unknown origin.