Requiring Chest Tube Placement Research Articles

Efficacy of needle tract embolization using gelfoam in reducing incidence of pneumothorax in CT-guided transthoracic lung biopsies: a systematic review and meta-analysis.

Transthoracic CT-guided lung biopsy is associated with risk of pneumothorax, requiring chest tube placement at times. From available literature, we tried to compare the incidence rate of pneumothorax in cases undergoing CT-guided lung biopsy with versus without use of gelfoam slurry for tract occlusion. Databases like SCOPUS, PubMed, Google Scholar, and EMBASE were searched for original studies analysing the efficacy of gelfoam for needle tract embolization following CT-guided lung biopsy till September 2023. Bias in the selected studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Pooled odds ratio of the effect of gelfoam slurry on the rate of pneumothorax and chest tube placement following CT-guided lung biopsy was calculated and represented with 95% confidence intervals (95% CI) and prediction interval (PI). Pooled analysis of six studies revealed that patients undergoing needle tract embolization when compared to non-embolized patients had a significantly decreased risk of pneumothorax with odds reduced by 59% (OR = 0.41, 95% CI = 0.25-0.66, P = .01; PI = -1.694 to 0.094). Also, it led to a significant reduction in severe pneumothorax requiring chest tube placement with reduced odds by 63% (OR = 0.37, 95% CI = 0.20-0.69, P = .01; PI = -1.855 to 0.115). Needle tract embolization using gelfoam has a significant protective effect against pneumothorax as well as chest tube insertion in patients undergoing CT-guided lung biopsy. Gelfoam needle tract embolization can effectively reduce the risk of pneumothorax and chest tube requirement after lung biopsy. CRD42024505788.

Combined antegrade and retrograde dilation (CARD) for management of complete esophageal obstruction: Multicenter case series.

Background and study aims Complete esophageal obstruction (CEO) is a rare complication of radiation therapy for esophageal or head and neck cancers and can be challenging to manage endoscopically. A rendezvous approach by combined anterograde and retrograde endoscopic dilation (CARD) can be used to re-establish luminal integrity in such cases. Our study aimed to review our experience with patients with CEOs managed by CARD. Patients and methods Six patients who had CARD for CEO were reviewed. The primary outcomes were immediate technical and clinical success of CARD. Secondary outcomes were adverse events (AEs) associated with the procedure and continued dependency on the percutaneous endoscopic gastrostomy (PEG)-or jejunostomy tube. Results The mean age was 59 years (range 38-83). Five patients had CEO secondary to neoadjuvant chemoradiotherapy for esophageal cancer, and one patient had complete obstruction secondary to neck trauma. CARD was technically successful in five patients (86%). Two patients had AEs. One had pneumomediastinum requiring no intervention, while the other had bilateral pneumothorax requiring chest tube placement. The median follow-up duration of repeated dilations to maintain liminal patency was 20 months. Four patients had improvement in dysphagia, tolerating oral intake, and mouth secretions after the procedure, with a mean functional oral intake scale (FOIS) score > 3 and an overall success rate of 83%. Conclusions The CARD approach to re-establish esophageal luminal patency in CEO is a safer alternative to high-risk blind antegrade dilation or an invasive surgical approach. It is usually technically feasible with improved swallowing ability in most patients.

Efficacy and Safety of 20G vs. 22G Needles in CT-Guided Transthoracic Fine Needle Aspiration Biopsies

Aim: This study aims to compare the diagnostic accuracy and complication rates of 20G and 22G needles in transthoracic fine needle aspiration biopsy (TFNAB). Method: This retrospective study reviewed lung biopsy results from procedures performed between January 2018 and March 2020. Patients included had non-diagnostic bronchoscopic biopsies or were deemed inappropriate for bronchoscopic biopsy. A total of 127 patients underwent Computed tomography (CT) guided TFNAB using either 20G or 22G needles. Data on lesion size, localization, diagnostic adequacy, and complications were collected and analyzed. Results: The study cohort included 127 patients with a mean age of 63.21 years. Of these, 72 underwent biopsies with a 22G needle and 55 with a 20G needle. The overall diagnostic accuracy was 96.8%, with no significant differences between the 20G and 22G needle groups (p=0.206). Complications occurred in 59 patients (46.5%), with pneumothorax being the most common, and two cases required chest tube placement. The rate of pulmonary hemorrhage was 18.9%. There were no significant differences in complication rates between the needle sizes (p=0.985). Conclusion: CT-guided TFNAB using both 20G and 22G needles is safe and effective, with high diagnostic accuracy and low complication rates. The choice of needle size does not significantly impact diagnostic outcomes or complication rates, allowing clinicians flexibility based on patient-specific factors and procedural requirements.

Impact of radiomics features, pulmonary emphysema score and muscle mass on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies

Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70–0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.

Point-of-Care Ultrasound for Earlier Detection of Pediatric Pneumonia.

An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia. Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

A chest tube after robotic thymectomy is unnecessary

ObjectiveChest tubes are frequently placed after thymectomy, without data to support this common practice. We report our experience in eliminating them after robotic thymectomy. MethodsThis is a retrospective database review of patients who underwent robotic thymectomy performed by a single surgeon in which intraoperative chest tube insertion was not planned. Patient characteristics and postoperative outcomes are presented. ResultsBetween January 2018 and October 2022, 75 patients underwent robotic thymectomy performed by a single surgeon. Of those, 64 (85.3%) underwent a left-sided thoracic approach. The most common indication for resection was a suspicious anterior mediastinal mass. There were no conversions to an open operation. The median operative time was 72 minutes (range, 38-164 minutes), and the median estimated blood loss was 20 cc (range, 10-60 cc). Ten patients (13.3%) went home on the day of surgery, and all others (86.7%) were discharged on postoperative day 1. A chest tube was placed in 1 patient at time of closure because of a persistent air leak after extensive adhesiolysis from a prior thoracotomy; the tube was removed on the day of surgery after resolution of the air leak. No other patient required chest tube placement intraoperatively, immediately postoperatively, or within 60 days postoperation. Two patients underwent outpatient thoracentesis within 1 month postoperation for effusions. There were no 30- or 90-day mortality and no major morbidities. ConclusionsA chest tube after robotic thymectomy is not necessary in almost all patients and can be safely omitted. The dogmatic routine practice of chest tube placement should be questioned.

Radiation dose of cone beam CT combined with shape sensing robotic assisted bronchoscopy for the evaluation of pulmonary lesions: an observational single center study.

Shape sensing robotic-assisted bronchoscopy (ssRAB) combined with radial endobronchial ultrasound (r-EBUS) and cone beam computed tomography (CBCT) is a newer diagnostic modality for the evaluation of pulmonary lesions. There is limited data describing the radiation dose of CBCT combined with ssRAB. The purpose of this study was to describe the technical factors associated with the use of CBCT combined with ssRAB to biopsy pulmonary lesions. We conducted a single center, prospective observational study of patients undergoing ssRAB combined with fixed CBCT for the pulmonary lesion biopsy. We report our patient demographics, and pulmonary lesion and procedure characteristics. A total of 241 ssRAB procedures were performed to biopsy 269 pulmonary lesions. The mean lesion size was measured in the following dimensions: anteroposterior (18.0±8.8 mm), transverse (17.2±10.5 mm), and craniocaudal (17.7±10.2 mm). A mean of 1.5±0.7 (median: 1, range: 1-4) CBCT spins were performed. The mean total fluoroscopy time (FT) was 5.6±2.9 minutes. The mean radiation dose of cumulative air kerma (CAK) was 63.5±46.7 mGy and the mean cumulative dose area product (DAP) was 22.6±16.0 Gy·cm2. Diagnostic yield calculated based on results at index bronchoscopy was 85.9%. There was a low rate of complications with 8 pneumothoraces (3.3%), 5 (2.1%) of which required chest tube placement. We describe the use of ssRAB combined with CBCT to biopsy pulmonary lesions as a safe diagnostic modality with relatively low radiation dose that is potentially comparable to other image guided sampling modalities. Bronchoscopists should be cognizant of the radiation use during the procedure for both patient and staff safety.

Machine-Learned Algorithms to Predict the Risk of Pneumothorax Requiring Chest Tube Placement after Lung Biopsy

PurposeTo develop a machine-learned algorithm to predict the risk of postlung biopsy pneumothorax requiring chest tube placement (CTP) to facilitate preprocedural decision making, optimize patient care, and improve resource allocation. Materials and MethodsThis retrospective study collected clinical and imaging features of biopsy samples obtained from patients with lung nodule biopsy and included information from 59 procedures resulting in pneumothorax requiring CTP and randomly selected 67 procedures without CTP (convenience sample). The data were divided into 70 and 30 as training and testing sets, respectively. Conventional machine-learned binary classifiers were explored with preprocedural imaging and clinical data as input features and CTP as the output. ResultsThere was no single pathognomonic imaging or predictive clinical feature. For the independent test set under the high-specificity mode, a decision tree, logistic regression, and Naïve Bayes classifier achieved accuracies of identifying CTP at 0.79, 0.93, and 0.89 and area under receiver operating curves (AUROCs) of 0.68, 0.76, and 0.82, respectively. Under high-sensitivity mode, a decision tree, logistic regression, and Naïve Bayes achieved accuracies of identifying CTP of 0.60, 0.45, and 0.60 with AUROCs of 0.71, 0.81, and 0.82, respectively. High importance features included lesion character, chronic obstructive pulmonary disease, lesion depth, and age. A coarse decision tree requiring 4 inputs achieved comparable performance as other methods and previous machine learning prediction studies. ConclusionsThe results support the possibility of predicting pneumothorax requiring CTP after biopsy based on an automated decision support, reliant on readily available preprocedural information.

Diagnostic Accuracy and Complications Rate of CT-guided Core Needle Lung Biopsy of Solid and Part-solid Lesion: A Single-institution Experience

Purpose: The aim of this study was to retrospectively analyze the diagnostic accuracy and risk factors of complications of percutaneous CT-guided transthoracic lung core needle biopsy (CT–TTLB) by stratifying pulmonary lesions by size and consistency. The secondary purpose of this study was to retrospectively evaluate the feasibility and safety of 1-hour patient discharge after (CT–TTLB). Methods: 170 lung biopsies were performed using a semi-automated true-cut needle. There were 116 (68.2%) male and 54 (31.8%) female patients, with a mean age of 60.9±14.24 years (19–91 years). The mean lesion's longest diameter was 6.08±3.33 cm. The lesions were stratified into solid and part-solid lesions. Diagnostic accuracy and adequacy were calculated for all biopsies and for each group separately, as well as the incidence of complications. Complications were stratified into early (discovered within the first hour after biopsy) and delayed (after 1 hour of biopsy) to assess the safety of 1 hour of patient discharge after (CT–TTLB). Results: The overall diagnostic accuracy was 80.6%, with no significant difference between small and large lesions, nor with solid and part-solid lesions. An adequate sample for NGS testing was obtained in 135 core biopsies (79.4%). The most frequent complication was perilesional intrapulmonary hemorrhage and the second most frequent complication was small pneumothorax; seen at a rate of 26% and 15.2% respectively. Large pneumothorax requiring chest tube placement occurred in one patient (1.1%). Most of the biopsy-related complications (98.9%) were discovered in the first hour of the biopsy with only two patients presenting to the ER with the delayed incidence of pneumothorax, which was treated conservatively. Conclusion: Diagnostic accuracy and adequacy were not affected by lesion characteristics or the number of samples. Larger gauge needles and smaller and deeply located nodules were found to have higher complication rates, compared to the larger size, solid, and peripherally located masses. Early discharge after CT-TTLB is associated with little morbidity and no mortality.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Thermal ablation for primary and metastatic lung tumors: Single-center analysis of peri-procedural and intermediate-term clinical outcomes

PurposeTo evaluate the peri-procedural and intermediate-term clinical outcomes of thermal ablation of primary and metastatic lung cancer through analysis of a 5-year institutional experience. MethodsIn this retrospective, IRB-approved study, 55 consecutive lung ablation interventions (33 cryoablation and 22 microwave ablations) performed at an academic medical center from 2017 to 2022 were evaluated. Cryoablation was performed utilizing multiple 14-guage probes using a triple freeze/thaw protocol. Microwave ablation required a single 14-guage probe, set to 60–80 watts for 5–10 min. Lung disease distribution was 58.2 % bilateral with largest lesion size of 5.5 cm. Periprocedural outcomes including technical success and complications as well as long-term outcomes including radiographic response, objective response ratio (ORR), disease control rate (DCR), progression free survival (PFS), overall survival (OS), and functional status were elucidated. ResultsTechnical success rate was 100 %. The most common complication was pneumothorax which occurred in 36 (65.5 %) patients, with 27 (49.1 %) requiring chest tube placement. At 6 months, 52 (98.2 %) of the patients demonstrated a complete response and 1 patient exhibited a partial response, yielding an ORR and a DCR of 100 %. The PFS was 26 ± 19 months, and the OS was 90.9 %, 83.6 %, and 74.5 % at 1, 3, and 5 years, respectively. Additionally, 92.7 % (51) of patients maintained or improved their functional status (ECOG) at 6 months. ConclusionPercutaneous thermal ablation techniques are evolving and promising treatments for both primary and metastatic lung tumors. Our 5-year institutional experience demonstrated their safety and efficacy with preservation of functional performance.

Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients.

The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB). Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged. CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57). This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.

Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors.

To compare the incidence of persistent air leak (PAL) following cryoablation vs MWA of lung tumors when the ablation zone includes the pleura. This bi-institutional retrospective cohort study evaluated consecutive peripheral lung tumors treated with cryoablation or MWA from 2006 to 2021. PAL was defined as an air leak for more than 24h after chest tube placement or an enlarging postprocedural pneumothorax requiring chest tube placement. The pleural area included by the ablation zone was quantified on CT using semi-automated segmentation. PAL incidence was compared between ablation modalities and a parsimonious multivariable model was developed to assess the odds of PAL using generalized estimating equations and purposeful selection of predefined covariates. Time-to-local tumor progression (LTP) was compared between ablation modalities using Fine-Gray models, with death as a competing risk. In total, 260 tumors (mean diameter, 13.1mm ± 7.4; mean distance to pleura, 3.6mm ± 5.2) in 116 patients (mean age, 61.1years ± 15.3; 60 women) and 173 sessions (112 cryoablations, 61 MWA) were included. PAL occurred after 25/173 (15%) sessions. The incidence was significantly lower following cryoablation compared to MWA (10 [9%] vs 15 [25%]; p = .006). The odds of PAL adjusted for the number of treated tumors per session were 67% lower following cryoablation (odds ratio = 0.33 [95% CI, 0.14-0.82]; p = .02) vs MWA. There was no significant difference in time-to-LTP between ablation modalities (p = .36). Cryoablation of peripheral lung tumors bears a lower risk of PAL compared to MWA when the ablation zone includes the pleura, without adversely affecting time-to-LTP. • The incidence of persistent air leaks after percutaneous ablation of peripheral lung tumors was lower following cryoablation compared to microwave ablation (9% vs 25%; p = .006). • The mean chest tube dwell time was 54% shorter following cryoablation compared to MWA (p = .04). • Local tumor progression did not differ between lung tumors treated with percutaneous cryoablation compared to microwave ablation (p = .36).

Feasibility and Safety of Transbronchial Lung Cryobiopsy for Diagnosis of Acute Respiratory Failure with Mechanical Ventilation in Intensive Care Unit.

Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU. Patients who underwent bronchoscopy examinations with transbronchial lung cryobiopsy (TBLC) between July 2018 and December 2019 were retrospectively analyzed through medical chart review. The procedures were performed by well-experienced interventional pulmonologists. Ten patients underwent bronchoscopy examinations with TBLC in the ICU at Chang Gung Memorial Hospital during the study period. In all patients, the diagnosis was made via pathological analysis. One patient developed pneumothorax and required chest tube placement after the procedure. None of the patients had bleeding requiring blood transfusion, and no deaths were directly related to the procedure. TBLC is a feasible technique to obtain lung pathology in patients with acute respiratory diseases of unknown etiologies. While the complication rate may be acceptable, the procedure should be performed by experienced interventional pulmonologists. However, airway blockers and fluoroscopy are highly recommended when used according to the current guideline. We do not encourage TBLC to be performed without having airway blockers available at the bedside.

Excellent results seen with both transaxillary and infraclavicular approaches to first rib resection in patients with subclavian vein thrombosis

BackgroundVenous thoracic outlet syndrome (VTOS) is a debilitating condition with several well-documented treatment paradigms. We reviewed the outcomes from a large academic institution of patients who had undergone transaxillary first rib resection with delayed venography (TA) or infraclavicular first rib and subclavius muscle resection with concomitant venography (ICV) for VTOS with subclavian vein thrombosis. MethodsWe performed a retrospective review of the medical records of all patients who had undergone first rib resection and scalenectomy for VTOS with subclavian vein thrombosis at a single academic institution. The demographics, presentation, operative records, and outcomes were collected. Descriptive statistics were used to compare the two groups. ResultsA total of 73 patients had undergone first rib resection for VTOS during the study period. Of the 73 patients, 36 (49%) had presented with thrombosis of the subclavian vein and were included in the present review. Of the 36 patients, 26 (72%) had undergone TA and 10 (28%) had undergone ICV. No significant differences were seen between the two groups in female gender (54% vs 50%; P = 1.00) or age (28.7 years vs 29.5 years; P = .88). A higher percentage of the ICV group had undergone preoperative thrombolysis (70% vs 27%; P = .02). All the patients in the ICV group had undergone intraoperative balloon venoplasty at resection. The mean time from thrombosis to resection was 2.3 months. All of the TA group had undergone venography at 2 weeks postoperatively. Venography had revealed 15 stenotic veins requiring venoplasty, 8 widely patent veins, 1 acutely thrombosed vein, and 3 chronically occluded veins. The time from initial thrombosis to surgical intervention was 10 months for the patent group, 6 months for the stenotic group, and 4 months for the occluded group. In the TA group, 19% of the patients had required chest tube placement intraoperatively for pneumothorax. In the ICV group, complications included postoperative hematoma (n = 1), wound infection (n = 1), and hemothorax (n = 1). The mean length of stay was 1.04 days for the TA group and 2.00 days for the ICV group (P < .0001). The mean follow-up was 10.4 months and 15.8 months for the TA and ICV groups, respectively. No mortalities were reported. No differences in the vein patency rates were seen between the two groups at follow-up (TA, 93%; vs ICV, 100%; P = 1.00). All the patients were asymptomatic at follow-up. ConclusionsThe outcomes for the patients who had undergone TA or ICV for subclavian vein thrombosis were excellent with no mortality and few complications. The subclavian vein patency rates were high, and all the patients were asymptomatic at follow-up.

A RARE CASE OF DISSEMINATED MYCOBACTERIUM AS THE CAUSE OF RECURRENT PNEUMOTHORAX

A RARE CASE OF DISSEMINATED MYCOBACTERIUM AS THE CAUSE OF RECURRENT PNEUMOTHORAX

INDWELLING PLEURAL CATHETERS FOR TREATMENT OF RECURRENT PLEURAL EFFUSION DUE TO CONGESTIVE HEART FAILURE: A SINGLE CENTER EXPERIENCE

INDWELLING PLEURAL CATHETERS FOR TREATMENT OF RECURRENT PLEURAL EFFUSION DUE TO CONGESTIVE HEART FAILURE: A SINGLE CENTER EXPERIENCE

Safety and efficacy of percutaneous liver ablation in gynecologic oncology patients with oligometastatic disease (543)

<b>Objectives:</b> To describe the safety and efficacy of percutaneous liver ablation (PA) performed by interventional radiology (IR) in gynecologic oncology patients with liver-dominant oligometastatic disease. <b>Methods:</b> This retrospective cohort included all adult women (>21 years) with a gynecologic malignancy who underwent PA for liverdominant oligometastatic disease from August 2016 to June 2021 at our institution. Age, Charlson comorbidity index (CCI), diagnosis, performance status (PS), prior cancer therapies, technical details of PA, complications, tumor response (complete, stable disease, and progression), and recurrence were evaluated. Descriptive statistics were performed using SPSS v. 26. <b>Results:</b> Thirteen women (median age: 63 [range: 45-77]; median CCI: 8 [range: 6-11]; median PS=0 [range: 0-2]) were included who underwent 21 PAs. Eight patients (61.5%) had recurrent ovarian cancer, while five patients (38.5%) had recurrent endometrial cancer. All patients had liver-dominant, oligometastatic disease with treated tumors ranging from 1.3-4.5cm. The median number of procedures was one (range: 1-4). Three women had multiple procedures. Patients most commonly underwent microwave ablation (<i>n</i>=17/21; 81%) or cryoablation (<i>n</i>=4/21; 19%). Patients had received a median of three anticancer therapies (range: 1-6) prior to PA in addition to primary surgery, with the most common being chemotherapy. About 66.7% of PA procedures (<i>n</i>=14/21) resulted in a complete response to treatment. Three procedures (14.3%) resulted in stable disease. Thus, 17/21 procedures (81%) resulted in local control. Four patients (19%) had disease progression in the liver consisting of new metastases not targeted during the PA ablation procedure. Eight out of 13 patients (61.5%) had no further evidence of liver metastases during their disease or treatment course. There were two major complications: a grade 3 liver abscess requiring drain placement and IV antibiotics and a grade 3 pneumothorax requiring chest tube placement. Two minor complications included a perihepatic hematoma (grade 1) and an asymptomatic pneumothorax (grade 1). PA did not result in any complication with permanent sequelae or grade 4 or 5 adverse events. <b>Conclusions:</b> PA is an effective therapeutic option for gynecologic oncology patients with liver-dominant oligometastatic disease. More than 80% of procedures result in disease control, and two-thirds of procedures achieve a complete response with an acceptable safety profile. This image-guided, minimally-invasive procedure provides an additional tool for managing oligometastatic disease in the liver for appropriately-selected patients. A multi-disciplinary approach is crucial in treating these complex patients.

A RARE CASE OF BRONCHOLITHIASIS PRESENTING WITH CHRONIC COUGH AND MEDIASTINAL ABSCESS

TYPE: Case Report TOPIC: Disorders of the Mediastinum INTRODUCTION: Broncholithiasis is a rare condition characterized by the erosion of calcified material into the tracheobronchial tree. We present a case of broncholithiasis complicated by mediastinal abscess. CASE PRESENTATION: A 58-year-old male presented with chronic cough and lithoptysis. Chest PET-CT demonstrated calcified right infrahilar and subcarinal soft tissue with avid FDG uptake. Infectious workup was negative, including histoplasma and mycobacterium testing. Bronchoscopy demonstrated mucosal inflammation around the bronchus intermedius. Endobronchial biopsies and EBUS-TBNA were negative for malignancy. Symptoms persisted despite multiple courses of antibiotics and prednisone. Repeat CT showed evolving mediastinal fluid collection and gas. The patient underwent right lower lobectomy and mediastinal lymphadenectomy which showed broncholithiasis, necrotizing granulomas as well as fibrinous and organizing inflammation. Following surgery, he developed right hydropneumothorax requiring chest tube placement with polymicrobial growth consistent with empyema. He was treated with IV antibiotics with subsequent resolution of his symptoms. DISCUSSION: Broncholithiasis is an exceedingly rare cause of chronic cough. Tuberculous and histoplasma necrotizing granulomatous lymphadenitis are the most common causes. Lithoptysis is an uncommon, but a unique symptom of broncholithiasis. Mediastinal abscess is a rare complication as seen in this case. Diagnosis is established by CT imaging and bronchoscopy plays and important role. Depending on disease severity, management options range from observation to bronchoscopic extraction to surgical resection. Caution is advised when bronchoscopic treatment is considered due to the risk of massive bleeding upon manipulation of broncholiths. CONCLUSIONS: Broncholithiasis is a rare complication of mediastinal granulomatous processes that can present with chronic cough, hemoptysis as well as mediastinal abscess. DISCLOSURE: Nothing to declare.

Complications of Endobronchial Valve Placement for Bronchoscopic Lung Volume Reduction: Insights From the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE).

Patients with advanced emphysema experience breathlessness due to impaired respiratory mechanics and diaphragm dysfunction. Bronchoscopic lung volume reduction (BLVR) is a minimally invasive bronchoscopic procedure done to reduce hyperinflation and air trapping, promoting atelectasis in the targeted lobe and allowing improved respiratory mechanics. Real-world data on safety and complications outside of clinical trials of BLVR are limited. We queried the US Food and Drug Administrations (FDA) Manufacturers and User Device Experience database from May 2019 to June 2020 for reports involving BLVR with endobronchial valve (EBV) placement. Events were reviewed for data analysis. We identified 124 cases of complications during BLVR with EBV implantation. The most-reported complication was pneumothorax (110/124, 89%), all of which required chest tube placement. A total of 54 of these cases (54/110, 49%) were complicated by persistent air leak requiring additional interventions. Repeat bronchoscopy was needed to remove the valves in 28 patients, 12 were discharged with a Heimlich valve, and 10 had an additional pleural catheter placed. The other complications of BLVR with EBV placement included respiratory failure (6/124, 5%), pneumonia (4/124, 3%), hemoptysis (2/124, 1.6%), valve migration (1/124, 1%), and pleural effusion (1/124, 1%). A total of 14 deaths were reported during that year. Pneumothorax is the most-reported complication for BLVR with EBV placement, and in 65% of cases, pneumothorax is managed without removing valves. Importantly, 14 deaths were reported during that timeframe. Further studies are needed to estimate the true magnitude of the complications associated with BLVR.