Lung Biopsy or Ablation Related Life-Threatening Bleeding: How I Manage It

Robert Suh, MD of the David Geffen School of Medicine at UCLA, presents on the critical topic of lung biopsy or ablation-related hemorrhage, providing insights into the differentiation and management of three distinct types of bleeds encountered in the lung and chest cavity.
 

During the 2023 Symposium on Clinical Interventional Oncology (CIO), Robert Suh, MD of the David Geffen School of Medicine at UCLA, presented on the critical topic of lung biopsy or ablation-related hemorrhage, providing insights into the differentiation and management of three distinct types of bleeds encountered in the lung and chest cavity. With a focus on pulmonary hemorrhage, extrapleural hematoma, and hemothorax, Dr. Suh outlined strategic approaches to handle each complication effectively.

Pulmonary hemorrhage, occurring within the lung parenchyma, demands immediate attention to securing the airway. Dr. Suh stressed the significance of endotracheal intubation, selective or split tube procedures, aggressive suctioning, and the consideration of endobronchial occlusion or blockers on the affected side. The top priority in cases of pulmonary hemorrhage is to stabilize the patient's airway to prevent life-threatening consequences.

Extrapleural hematoma, a bleed in a soft tissue compartment outside the formal pleural space, presents a unique challenge. Dr. Suh highlighted the potential for self-tamponade as pressure rises within this soft tissue space. Recognizing extrapleural hematomas involves identifying a displaced band of extra pleural fat, and in stable patients, intervention may include searching for the bleed source and embolization if required.

In contrast, hemothorax involves bleeding into the formal pleural space, posing a severe risk if left unchecked. Dr. Suh underscored the importance of evaluating the rate and quantity of blood in the pleural space. For clinically unstable patients, urgent interventions like video-assisted thoracoscopic surgery (VATS) or thoracotomy may be necessary. Conversely, for stable patients, the placement of a chest tube becomes crucial if the blood volume exceeds 300 cm³ [MOU1] . Careful monitoring and resuscitation are imperative in both scenarios.

Dr. Suh also provided a comprehensive guide to assessing the amount of blood in the pleural space based on its anteroposterior diameter, aiding clinicians in determining the severity of the bleed. Throughout the presentation, Dr. Suh emphasized the importance of appropriate supportive care tailored to each specific type of hemorrhage.

Dr. Robert Suh's presentation offered a thorough understanding of the nuanced management strategies required for diverse lung biopsy or ablation-related hemorrhages. His insights underscored the critical role of timely intervention, differentiation of bleed types, and a patient-centered approach to achieve optimal outcomes in clinical practice.