62 years old with solitary pulmonary lesion

62 years old with solitary pulmonary lesion

  • 62 years old, bleeding per rectum for 4 months
  • Diagnosed carcinoma of rectum with lung and nodal metastasis
  • Underwent right thoracotomy, metastasectomy and lymphadenectomy for lung and nodal metastasis
  • 20 month after the surgery, developed a solitary right lung lesion adjacent to previous surgical site
  • Figure 1 (a, b): sagittal and axial images of the chest CT obtained 20 months after metastasectomy demonstrates a new oval soft tissue lesion with spiculated margins adjacent to the post-surgical changes.
  • Figure 2 (a): Pre-ablation planning CT
  • Figure 2 (b): Intra-procedural CT demonstrating RFA electrode within the lesion
  • Figure 3: Axial CT image immediately after ablation shows cavitation of the lesion with perilesional ground-glass opacification.

Radiofrequency ablation of lung metastasis


Treatment options for lung metastasis

  • Surgical resection
  • Laser-Induced Thermotherapy
  • Radiofrequency Ablation
  • Microwave Ablation
  • Radiofrequency ablation offers a similar median survival range as of surgical metastasectomy
  • Advantages of thermal ablation
    • Minimal effect on pulmonary function/quality of life
    • Can be repeated
    • Short hospital stay
    • Does not require interruption of chemotherapy

Mechanism of action:

  • Thermal energy  damage to cellular proteins, enzymes, & nucleic acids  creates tissue necrosis and coagulation
  • RFA is indicated in small (<3 cm) solitary lung lesions located peripherally.
  • The lesion should not be contiguous with major vessels as it can lead to heat sink effect.
  • Relative contraindications for the procedure include underlying interstitial disease, coagulopathies and immediate proximity to sensitive structures such as central airways, major vascular structures or esophagus.
  • Rarely, the procedure is complicated by bronchopleural fistula, tumor seeding, neural or diaphragmatic injury.


  • Most frequent complications include
    • Pleuritis
    • Pneumonia
    • Abscess
    • Hemorrhage
    • Refractory pneumothorax requiring pleurodesis
  • Major complications are rare and include
    • Bronchopleural fistula
    • Tumor seeding
    • Nerve or diaphragmatic injury.


  1. Vogl TJ, Eckert R, Naguib NN, Beeres M, Gruber-Rouh T, Nour-Eldin NE. Thermal ablation of colorectal lung metastases: retrospective comparison among laser-induced thermotherapy, radiofrequency ablation, and microwave ablation. American Journal of Roentgenology. 2016 Dec;207(6):1340-9.
  2. Ridge CA, Solomon SB. Percutaneous ablation of colorectal lung metastases. Journal of gastrointestinal oncology. 2015 Dec;6(6):685.
  3. Bhatia S, Pereira K, Mohan P, Narayanan G, Wangpaichitr M, Savaraj N. Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know. The Indian Journal of Radiology & Imaging. 2016 Jan;26(1):81.

Dr Rajesh Helavar
Consultant Interventional Radiology
Columbia Asia Radiology Group

Dr Renu Jadiya
DNB Resident
Columbia Asia Radiology Group