Permissions and Reprints(opens in new window)

Abstract

Indocyanine green fluorescence (ICG-F)-guided surgery has, in recent years, optimized the precision and safety of surgical procedures.

Although its applications are increasingly widespread, in most cases, the dye is administered intravenously.

We present a case of inhaled indocyanine green use for the identification and resection of pulmonary metastatic nodules.

A 12-year-old female patient with a history of sternal Ewing sarcoma with bone and pulmonary metastases was treated with chemotherapy, proton therapy, partial sternal and costal cartilage resection, and reconstruction with mesh and absorbable plates.

She later developed pulmonary relapse, with two subpleural metastases identified in segments 6 and 9 of the right lung. After initiating chemotherapy, thoracoscopic surgery was planned to resect the nodules.

Before surgery, nebulization of indocyanine green was performed via an endotracheal tube at 0.2 mg/kg using an inhalation chamber for 5 minutes at 6 liters per minute.

During surgery, fluorescence was observed in the insufflated lung parenchyma, allowing for clear differentiation of metastatic nodules from peripheral fibrotic or inflammatory tissue and enabling a safe wedge resection of both lesions.

The postoperative period was uneventful, and the patient is currently completing postoperative chemotherapy cycles.

Keywords indocyanine green - thoracic pediatric surgery - inhaled Authors' Contribution

Á.J.G.F.: conceptualization, methodology, writing—original draft, writing—review and editing; J.A.M.D.: visualization; J.F.N.P.: supervision, visualization; E.D.M.: visualization; C.P.G.: visualization; R.F.-V.: supervision, visualization.

Publication History

Received: 13 April 2025

Accepted: 30 December 2025

Accepted Manuscript online:
04 January 2026

Article published online:
24 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany