Current surgical assumptions identify the lateral femoral cutaneous nerve (LFCN) running just under the inguinal ligament two fingerbreadths medial to the anterior superior iliac spine (ASIS). On the basis of the increasing incidence of Meralgia Paresthetica associated with various surgical procedures, it is clear that surgeons are relying on an inadequate description of the nerve's course. This study provides a better understanding of the variability of the LFCN with regards to its relationship to the ASIS and the depth at which it passes deep to the inguinal ligament. A total of 35 bodies were examined yielding 65 sets of data. Dissections were performed on 26 formalin fixed cadavers and 9 fresh morgue specimens. Measurements and calculations were made with regard to the distance from the LFCN to the ASIS along the inguinal ligament, the depth of the LFCN as it crossed the inguinal ligament, and the length of the inguinal ligament. The LFCN was observed to cross the inguinal ligament 1.4 +/- 0.4 cm medial to the ASIS with a standard deviation of 1.5 cm. The LFCN traversed the inguinal ligament 1.0 +/- 0.1 cm deep to the ligament with a standard deviation of 0.6 cm. The LFCN runs approximately one fingerbreadth medial to the ASIS. The nerve may be found far more medial or lateral than expected with several distinct branching patterns. In addition, the LFCN crosses deeper to the inguinal ligament than previously described in the literature, with a high variability of depth between specimens.

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Approximately 150,000 solitary pulmonary nodules are discovered annually in adults older than age 50 years, with 40% to 50% being malignant. 1 Histologic diagnosis is often impossible by radiographic assessment or bronchoscopy alone. The evolution of minimally invasive techniques like transthoracic biopsy guided by computed tomography (CT) and videoassisted thoracoscopic surgery (VATS) has offered alternatives other than open surgical biopsy for preoperative diagnosis.Although CT-guided biopsy and VATS are effective and valuable thoracic diagnostic procedures, preservation of oncologic principles remains an issue. Despite its rarity, tumor dissemination after transthoracic biopsy or VATS 2 is a potential risk. The significance of tumor seeding along the needle or port tract with respect to management of lung lesions suspected to be malignant, as well as the extent of treatment required and the overall impact on the patient's prognosis, has yet to be defined.Clinical summary. A 51-year-old man had Mycobacterium tuberculous peritonitis. A chest radiograph showed a 1.5 cm lung nodule in the left upper lobe. Medical history was noteworthy for pancreatitis, hypertension, and a 50 pack-year smoking history. Physical examination showed no abnormalities. CT scan of the chest and abdomen confirmed the presence of the mass and showed no mediastinal lymphadenopathy and no hepatic or adrenal masses. Bronchoscopic examination showed no intraluminal masses and washings were inconclusive. A CT scan-guided percutaneous biopsy was performed with a 0.8-mm diameter (20 gauge) screw tip needle (Rotex catheter, Ursus Corporation, Stockholm, Sweden), with two passes being made into the suspicious area. Pathologic study yielded malignant epithelial cells consistent with non-small cell cancer.The patient underwent a left upper lobectomy and mediastinal lymphadenectomy. A pathologic diagnosis of moderately differentiated adenocarcinoma (tumor size 1.2 × 1.1 × 1.0 cm) with normal (negative) lymph nodes was returned and classified as T1 N0 MX lung cancer. The patient did well after the operation and received no adjuvant therapy.

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