Radiofrequenzablation (RFA) bei pulmonalen Metastasen
Artificial
pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum. Artificial pneumothorax adjuvant RFA of pulmonary metastases contiguous to the mediastinum (a 67-year-old man with a metastatic lesion in the superior lobe forepart of right lung). Tumor size, 1.5 × 1.2 cm. a Before ablation, chest CT imaging was performed to evaluate the anatomic relationship between tumor and peripheral cardiovascular structures. b Subsequently, a 22-G needle tip was used to create a puncture that reached the outer edge of pleura for injection of 1–2 ml saline. c The needle tip entered into the pleura, and the saline in the tube flowed into the cavity. d-e CO2 gas was administered gradually with a syringe until the tumor was separated from the mediastinum. f CT image during RFA showed the electrode inserted into the tumor and located away from the mediastinum by proxy of artificial pneumothorax. g The ablation zone gradually increased following the RFA procedure. h After RFA, the pulmonary texture around tumor showed a circular exudation shadow with ground-glass appearance on CT image. i Contrast enhanced CT image 1 month after RFA showed no enhancement of the ablated tumor contiguous to the mediastinum. j-l The size of ablated tumor decreased gradually after RFA during follow up at 3, 6, and 12 months, respectively
Radiofrequenzablation (RFA) bei pulmonalen Metastasen
Radiofrequenzablation (RFA) Radiopaedia • CC-by-nc-sa 3.0 • de
Radiofrequency ablation (RFA) is a medical procedure that uses a high-frequency alternating current produced by a radiofrequency generator oscillating in a closed-loop circuit. This current heats a needle to over 60°C, which is used to cause intentional protein denaturation and tissue damage .
Applications
- tumor ablation: established for the local destruction of liver, lung, and bone tumors, e.g. HCC and osteoid osteoma
- cardiac arrhythmia: used in the treatment of an abnormally discharging focus within the heart
- ablation neurotomy and pain management for specific nerve plexuses or Morton neuroma
- varicose veins: an alternative to sclerotherapy, as the produced heat causes closure of the affected vein
Complications
- thermal injuries to the adjacent structures: in liver tumor ablation, this means potential injury to the diaphragm, colon, gallbladder, or bile ducts, which may result in perforation, leakage of secretions, or stricture formation
- pneumothorax and pleural effusion: in lung tumor ablation
- hemorrhage: small vessels are more liable to hemorrhage more than large vessels which are rather protected by "heat sink" effect of flowing blood
- infection is a relatively low risk of radiofrequency ablation
- tumor seeding along the needle tract
- post-ablation syndrome: flu-like symptoms, including low-grade fever, chills, nausea, pain, and malaise. It is a self-limited condition that usually begins three days after ablation
- dysfunction of a cardiac pacemaker or defibrillator due to the use of radiofrequency waves
Siehe auch:
Assoziationen und Differentialdiagnosen zu Radiofrequenzablation (RFA) bei pulmonalen Metastasen:
