Phrenic Nerve Injury Resulting from Percutaneous Ablation of Lung Malignancy
Raymond H. Thornton1,
Stephen B. Solomon1,
Damian E. Dupuy2 and
Manjit S. Bains3
1 Section of Interventional Radiology and Image-Guided Therapies, Department of
Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Ste. H118,
New York, NY 10021.
2 Department of Diagnostic Imaging, Rhode Island Hospital and the Warren Alpert
Medical School at Brown University, Providence, RI.
3 Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
NY.
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Fig. 1A —69-year-old man with stage IA right upper lobe
non–small cell lung carcinoma (NSCLC) referred for radiofrequency
ablation. Medical history was significant for chronic obstructive pulmonary
disease with shortness of breath on exertion requiring multiple inhalers,
sleep apnea requiring continuous positive airway pressure at night, diabetes,
and hypertension. Diagnostic inspiratory scan shows right upper lobe
NSCLC.
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Fig. 1B —69-year-old man with stage IA right upper lobe
non–small cell lung carcinoma (NSCLC) referred for radiofrequency
ablation. Medical history was significant for chronic obstructive pulmonary
disease with shortness of breath on exertion requiring multiple inhalers,
sleep apnea requiring continuous positive airway pressure at night, diabetes,
and hypertension. Combination of lower lung volumes during procedure and
posterior displacement of lesion caused by anterior approach substantially
alters relationship of lesion and ablation electrode to superior vena cava and
expected location of phrenic nerve.
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Fig. 1C —69-year-old man with stage IA right upper lobe
non–small cell lung carcinoma (NSCLC) referred for radiofrequency
ablation. Medical history was significant for chronic obstructive pulmonary
disease with shortness of breath on exertion requiring multiple inhalers,
sleep apnea requiring continuous positive airway pressure at night, diabetes,
and hypertension. Chest radiograph obtained after procedure shows differential
elevation of right hemidiaphragm, indicated by arrows.
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Fig. 2A —69-year-old man with stage IB non–small cell lung
carcinoma (NSCLC) and severe chronic obstructive pulmonary disorder precluding
surgical resection was referred for external beam radiation therapy and
percutaneous tumor ablation. Because of size of mass, three 3.7-cm active tip
microwave antennae (Vivawave System, Covidien) were inserted and single
10-minute ablation at 45 W was performed. CT scan shows left upper lobe NSCLC.
Arrow indicates anticipated location of left phrenic nerve.
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Fig. 2B —69-year-old man with stage IB non–small cell lung
carcinoma (NSCLC) and severe chronic obstructive pulmonary disorder precluding
surgical resection was referred for external beam radiation therapy and
percutaneous tumor ablation. Because of size of mass, three 3.7-cm active tip
microwave antennae (Vivawave System, Covidien) were inserted and single
10-minute ablation at 45 W was performed. For adequate coverage of tumor,
anterior microwave antenna is positioned in relatively close proximity to
expected location of phrenic nerve (arrow).
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Fig. 2C —69-year-old man with stage IB non–small cell lung
carcinoma (NSCLC) and severe chronic obstructive pulmonary disorder precluding
surgical resection was referred for external beam radiation therapy and
percutaneous tumor ablation. Because of size of mass, three 3.7-cm active tip
microwave antennae (Vivawave System, Covidien) were inserted and single
10-minute ablation at 45 W was performed. Chest radiograph obtained after
procedure shows elevation of left hemidiaphragm (arrow); this finding
is consistent with left phrenic nerve injury.
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Fig. 3A —84-year-old woman who had undergone resection of left lung
non–small cell lung carcinoma (NSCLC) 10 years earlier presented with
cough and pneumonia and was subsequently found to have a solitary PET-positive
nodule in right upper lobe abutting superior vena cava. Because of proximity
of nodule to expected location of right phrenic nerve, artificial pneumothorax
was induced using Safe-T-Centesis needle (Cardinal Health). CT scan obtained
before procedure shows close association of cystic, low-attenuation lung tumor
with posterolateral aspect of superior vena cava (arrow).
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Fig. 3B —84-year-old woman who had undergone resection of left lung
non–small cell lung carcinoma (NSCLC) 10 years earlier presented with
cough and pneumonia and was subsequently found to have a solitary PET-positive
nodule in right upper lobe abutting superior vena cava. Because of proximity
of nodule to expected location of right phrenic nerve, artificial pneumothorax
was induced using Safe-T-Centesis needle (Cardinal Health). Because of
proximity of right upper lobe mass to anticipated location of right phrenic
nerve adjacent to superior vena cava (large arrow), pneumothorax was
induced using needle (small arrow) as neuroprotective strategy.
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Copyright © 2008 by the American Roentgen Ray Society.
