title: Delayed development of pneumothorax after pulmonary radiofrequency ablation.
abstract: Acute pneumothorax is a frequent complication after percutaneous pulmonary radiofrequency (RF) ablation. In this study we present three cases showing delayed development of pneumothorax after pulmonary RF ablation in 34 patients. Our purpose is to draw attention to this delayed complication and to propose a possible approach to avoid this major complication. These three cases occurred subsequent to 44 CT-guided pulmonary RF ablation procedures (6.8%) using either internally cooled or multitined expandable RF electrodes. In two patients, the pneumothorax, being initially absent at the end of the intervention, developed without symptoms. One of these patients required chest drain placement 32 h after RF ablation, and in the second patient therapy remained conservative. In the third patient, a slight pneumothorax at the end of the intervention gradually increased and led into tension pneumothorax 5 days after ablation procedure. Underlying bronchopleural fistula along the coagulated former electrode track was diagnosed in two patients. In conclusion, delayed development of pneumothorax after pulmonary RF ablation can occur and is probably due to underlying bronchopleural fistula, potentially leading to tension pneumothorax. Patients and interventionalists should be prepared for delayed onset of this complication, and extensive track ablation following pulmonary RF ablation should be avoided.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. stephan.clasen@med.uni-tuebingen.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Clasen
authors.forename: Joachim
authors.initials: J
authors.lastname: Kettenbach
authors.forename: Bora
authors.initials: B
authors.lastname: Kosan
authors.forename: Hermann
authors.initials: H
authors.lastname: Aebert
authors.forename: Melanie
authors.initials: M
authors.lastname: Schernthaner
authors.forename: Stefan-Martin
authors.initials: SM
authors.lastname: Kröber
authors.forename: Andrea
authors.initials: A
authors.lastname: Bömches
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Pereira
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D015641:Radiography, Interventional; D012307:Risk Factors; D014057:Tomography, X-Ray Computed