Microwave Ablation to Cauterize a Bleed after CT-Guided Lung Biopsy

A 72-year-old man with a history of left lung squamous cell carcinoma underwent a biopsy of an enlarging 3.1 × 1.9-cm mass in the right upper lobe (Fig 1). A core biopsy resulted in severe bleeding (Fig 2), necessitating bronchoscopy that demonstrated blood emanating from the right lung. Computed tomography examination showed an active pulmonary parenchymal hemorrhage (Fig 3), ruling out endoscopic therapy. Microwave ablation was performed in an attempt to cauterize the bleed and ablate the lesion. Using continuous rotation computed tomography fluoroscopic guidance (Fig 4), two 20-cm 17-gauge microwave ablation probes (Neuwave PR; Ethicon, Madison, Wisconsin) bracketed the lesion; ablation was performed at 65 W for 10 minutes. The lateral probe was repositioned, and a second ablation was performed to ensure an adequate ablation zone because of the limited visualization from the hemorrhage. Cauterization with adequate hemostasis was confirmed by postprocedural imaging and bronchoscopy (Figure 5, Figure 6). Postoperative hemoptysis and intubation for a week resulted in discharge on postoperative day 10.