Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Nour-Eldin A. Nour-Eldin Nagy N. N. Naguib Martin Mack John E. Abskharon Thomas J. Vogl
- چاپ و سال / کشور: 2010
Description
Purpose To assess risk factors and the extent of pulmonary hemorrhage complicating radiofrequency ablation (RFA) of pulmonary neoplasms. Materials and Methods This retrospective study involved 248 ablation sessions for lung tumors (20 primary lesions and 228 metastatic lesions) in 164 patients (mean age 59.7years, SD: 10.2). Both unipolar and bipolar radiofrequency systems were used under CT fluoroscopic guidance. Extent and underlying factors associated with development of pulmonary hemorrhage were analyzed. Results Incidence of intraparenchymal pulmonary hemorrhage, pleural effusion, and hemoptysis were 17.7% (44/248 sessions), 4% (8/248 sessions), and 16.1% (40/248 sessions), respectively. Death because of massive bleeding occurred in one session (0.4%). Significant risk factors associated with intra-parenchymal hemorrhage included: lesions of <1.5cm diameter (P=0.007); basal and middle lung zone lesions (P=0.026); increased needle track distance traversing the lung parenchyma >2.5cm (P=0.0017); traversing pulmonary vessels in the track of ablation (P<0.001); and the use of multi-tined electrodes (P=0.004). Concomitant incidence of pulmonary hemorrhage and pneumothorax was 29.2% (14/48 sessions). Conclusion While typically safe, RFA of pulmonary neoplasms can result in pulmonary hemorrhage ranging from mild to lifethreatening. Management of this complication is mainly preventive through adequate patient selection for ablation therapy and exclusion of technically avoidable risk factors.
Eur Radiol (2011) 21: 197–204 DOI 10.1007/s00330-010-1889-1 Received: 2 October 2009/ Revised: 26 May 2010/ Accepted: 10 June 2010/ Published online: 28 July 2010
