Nour-Eldin Abdelrehim Nour-Eldin MSc,MD, Presenter: Nothing to Disclose

Nagy N. N. Naguib MSc, Abstract Co-Author: Nothing to Disclose

Ahmad Sami Saeed, Abstract Co-Author: Nothing to Disclose

Tatjana Gruber-Rouh, Abstract Co-Author: Nothing to Disclose

Thomas Lehnert MD, Abstract Co-Author: Nothing to Disclose

Thomas Josef Vogl MD, Abstract Co-Author: Nothing to Disclose

To assess risk factors and the extent of pulmonary haemorrhage complicating radiofrequency ablation (RFA) of pulmonary neoplasms.

This retrospective study involved 248ablation sessions for lung tumors (20primary lesions and 228metastatic lesions) in 164patients (92 male,72 female;mean age 59.7years SD:10.2) in the time period between March 2004 and January 2009.Both unipolar and bipolar radiofrequency systems were used under CT fluoroscopic guidance.Extent and underlying factors associated with development of pulmonary haemorrhage were analyzed by evaluating intra-procedural and post-procedural CT scans. Pulmonary haemorrhage was treated conservatively.Univariate analyses were performed by using Mann-Whitney U test for numerical values and the Fisher exact test for categorical values

Incidence of pulmonary haemorrhage and pleural effusion were 17.7%(44 of 248 sessions) and 4% (8 of 248 sessions) respectively.Haemoptysis varying between blood-tinged sputum to frank bleeding developed in 40out of 248(16.1%).Death due to massive bleeding occurred in one session out of 248(0.4%).Significant risk factors associated with intra-parenchymal haemorrhage included: Lesions of diameter <1.5cm (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).Pleural effusion related mainly to decreased length of the aerated lung traversed by the electrode <2.5cm(P= 0.04).The total incidence of pneumothorax in all sessions was 12.1 %(30 out of 248 patients).Concomitant incidence of pulmonary haemorrhage and pneumothorax was 29.2%(14 out of 48 sessions) with chest tube application required in 4 sessions.Premature termination of the ablation session before completion of the planned time of ablation was decided in 6 patients(12.5%)due to progressive respiratory distress.

While typically safe, RFA of pulmonary neoplasms can result in pulmonary haemorrhage ranging from mild to life threatening.Prompt interference should be used in case of uncontrolled haemorrhage causing respiratory distress.

Management of pulmonary haemorrhage during pulmonary ablation is mainly preventive through adequate patient selection for ablation therapy and exclusion of technically avoidable risk factors.

Nour-Eldin, N, Naguib, N, Saeed, A, Gruber-Rouh, T, Lehnert, T, Vogl, T, Pulmonary Haemorrhage Complicating Radiofrequency Ablation, from Mild Haemoptysis to Life Threatening Pattern.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9014226.html