Pleural complications in patients with renal cell carcinoma undergoing percutaneous cryoablation: A retrospective analysis of its incidence and risk factors.

RATIONALE: Observations from our clinical practice indicate a notable occurrence of pleural complications post-percutaneous renal cryoablation (PRC). OBJECTIVE: To identify the incidence of pleural complications following PRC and potential risk factors associated with post-procedural pleural complications. MATERIALS AND METHODS: This was a retrospective cohort analysis of patients undergoing PRC at two tertiary hospital systems between 2016 and 2022. Patient characteristics, radiological and clinical data, and procedure techniques were collected in a database to identify potential risk factors. RESULTS: A total of 285 patients were identified who underwent 312 PRC procedures during the specified inclusion period. Among these, 10 procedures (3.2 %) led to pleural complications, all manifesting as pleural effusions. Of these complications, 3 patients (1 %) required pleural drainage. Factors associated with an increased risk of pleural complications included a larger mean tumor size (4.3 cm vs 2.7 cm, P = <0.001), cryoprobe applicator entry at the T10-T11 level as opposed to lower sites (P = 0.029), and a higher median number of cryoprobe applicators employed (3.5 vs 2.0, P = 0.001). Moreover, individuals who experienced pleural complications had a longer median hospital stay (4.0 vs 0, P ≤ 0.001) and a higher rate of blood transfusions (40% vs 0.7 %, P ≤ 0.001). CONCLUSION: Pleural complications from percutaneous renal cryoablation are rare. To further reduce the risk, higher insertion points (above T12) and utilizing more than two cryoprobe applicators should be avoided when feasible. Pleural complications in patients with new respiratory symptoms after PRC should be considered.

A 61-Year-Old Man With Shortness of Breath and Eye Swelling.

CASE PRESENTATION: A 61-year-old man presented to the pulmonary clinic with symptoms of dyspnea and productive cough for the last 6 months. Within the last 2 months, he started noticing bulging of his eyes associated with blurry vision. He denied hemoptysis, fever, night sweats, weight loss, skin rash, and dry eyes or mouth. He is a former smoker, and he denied any recent travel history. The patient has a history of microscopic polyangiitis, which was treated with cyclophosphamide and mycophenolate maintenance therapy and has been in remission for the last 7 years.

A 74-Year-Old Man With Dyspnea.

CASE PRESENTATION: A 74-year-old man presented to the ED with progressive dyspnea, orthopnea, and bilateral leg swelling for 2 months. He denied cough, hemoptysis, fever, night sweats, or weight loss. He had history of COPD and chronic atrial fibrillation. He had a 50 pack-year smoking history and had quit 7 years prior to presentation.

Diagnosis of non-expandable lung using thoracic ultrasound.

Non-expandable lung (NEL) commonly occurs secondary to chronic pleural processes, including pleural effusions, endobronchial obstruction, atelectasis, or chronic pleural inflammatory processes. Patients with NEL frequently undergo unnecessary procedures (e.g., thoracentesis), resulting in pneumothorax and discomfort (usually chest pain). Identifying a chronic process and likely development of NEL may prevent this. Diagnostic modalities currently used in practice include pleural manometry and ultrasonography. This case report demonstrates that blunting of transmitted cardiac impulse on M-Mode of ultrasonography predicts the presence of NEL.