Approximately 30% of early stage lung cancer patients are not surgical candidates due to medical comorbidities, poor cardiopulmonary function and advanced age. These patients are traditionally offered chemotherapy and radiation, which have shown relatively modest improvements in mortality. For over a decade, percutaneous image-guided ablation has emerged as a safe, cost-effective, minimally invasive treatment alternative for patients who would otherwise not qualify for surgery. Although radiofrequency ablation (RFA) is currently the most extensively studied and widely utilised technique in the treatment of lung malignancies, there is a growing body of evidence that microwave ablation (MWA) has several unique benefits over RFA and cryoablation in the lung. This article reviews our institution's clinical experiences in the treatment of lung malignancies with MWA including patient selection, procedural technique, imaging follow-up, treatment outcomes and comparison of ablation techniques. ARTICLE HISTORY
A 26-yr-old female patient was referred with 10 mo of atraumatic, progressive right neck and arm pain that was exacerbated with overhead activity. She denied any history of trauma. Her medical history was significant for migraine headaches, controlled with topiramate. She initially sought treatment at an outside facility and was diagnosed with thoracic outlet syndrome. A 2-mo trial of physical therapy including scapular retractions and stretching exercises was mildly helpful in alleviating her symptoms. Cervical spine radiographs and MRI were unremarkable. Electrodiagnostic testing of the right upper extremity was normal.Physical examination revealed limitations in cervical spine range of motion secondary to pain. Passive shoulder range of motion was normal bilaterally. Wright_s and Roos tests were mildly positive bilaterally, right greater than left. Hawkin and Neer tests were negative bilaterally. Strength was grade 5 in the upper extremities bilaterally. She was tender to palpation inferior to the right clavicle in the region of the pectoralis minor. Upper extremity pinprick sensation was intact in the C5-T1 dermatomes. Reflexes were 2+ at the biceps, triceps, and brachioradialis bilaterally.A trial of increased topiramate failed to provide relief on 1-mo follow-up. Her persistent pain and debilitation prompted an MR neurography study for assessment of the brachial plexus. This study demonstrated an incidental cortically based lesion of the proximal right humerus with a central nidus and surrounding marrow edema, compatible with osteoid osteoma (Fig. 1). The patient was then referred to interventional radiology for CT-guided biopsy and radiofrequency ablation (Figs. 2 and 3). Pathology results confirmed the diagnosis of osteoid osteoma. The patient reported complete resolution of her pain at 1-mo and 3-mo follow-up visits.This case describes a rare manifestation of proximal humeral osteoid osteoma mimicking thoracic outlet syndrome. Osteoid osteoma is a painful benign osseous neoplasm with FIGURE 1 MRI neurography study. Proximal humeral osteoid osteoma.FIGURE 2 Preprocedural CT localization. Proximal humeral osteoid osteoma.
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