title: Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern.
abstract: OBJECTIVE
  To assess risk factors and the extent of pulmonary hemorrhage complicating radiofrequency ablation (RFA) of pulmonary neoplasms.
  
  
  METHODS
  This retrospective study involved 248 ablation sessions for lung tumors (20 primary lesions and 228 metastatic lesions) in 164 patients (mean age 59.7 years, 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 intra-parenchymal 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 <1.5 cm diameter (P=0.007); basal and middle lung zone lesions (P=0.026); increased needle track distance traversing the lung parenchyma>2.5 cm (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).
  
  
  CONCLUSIONS
  While typically safe, RFA of pulmonary neoplasms can result in pulmonary hemorrhage ranging from mild to life-threatening. Management of this complication is mainly preventive through adequate patient selection for ablation therapy and exclusion of technically avoidable risk factors.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. nour410@hotmail.com
authors.forename: Nour-Eldin A
authors.initials: NE
authors.lastname: Nour-Eldin
authors.forename: Nagy N N
authors.initials: NN
authors.lastname: Naguib
authors.forename: Martin
authors.initials: M
authors.lastname: Mack
authors.forename: John E
authors.initials: JE
authors.lastname: Abskharon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
mesh_terms: D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed