Hepatic Cryoablation-Induced Acute Lung Injury: Histopathologic Findings

Large Volume Hepatic Microwave Ablation Elicits Fewer Pulmonary Changes than Radiofrequency or Cryotherapy

“…3,10 Hepatic resection resulted in only mild perivascular oedema around lung capillaries without any other significant change. 4 Interestingly, systemic responses similar to those obtained from CRYO following ablation of 35% of the volume of normal liver occurred when 50-60% of the normal liver parenchyma were ablated with RFA. 11,12 These results suggest that hepatic tumour ablation that results from RFA-induced thermal coagulation produces a much lower systemic inflammatory insult than an equivalent ablation produced by cryotherapy.…”

“…10 Histological changes between 1 and 2 h following the procedure, resulting from the inflammatory process, consist of airspace oedema and parenchymal haemorrhages 4 , multiple foci of perivascular inflammation, activated lymphocytes, foamy macrophages and marginated neutrophils. 1,4 One week following RFA treatment, although the alveolar space was spared, there is a moderate interstitial pneumonia, and the alveolar septum was thickened with an infiltrate of mononuclear cells. Changes after CRYO were more obvious, and there was an additional perivenular inflammation with diffuse infiltration of polymorphs and monocytes into the alveolar and interstitial spaces.…”

“…1 The "cryoshock" syndrome is fatal in 0-8% of cases 2 and involves the lungs (pleural effusions, acute respiratory distress syndrome), kidneys (myoglobinuria, acute renal failure) and the hematopoietic system (marked thrombocytopenia). [1][2][3][4][5] The level of the injury and the subsequent clinical manifestation is directly proportional to the volume of liver which is ablated and the quantity of Mr. David Lloyd had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. necrotic debris released.…”

Cryosurgery: Early Ultrastructural Changes in Liver Tissue In Vivo

“…Animals underwent 35% hepatic resection or a similar volume hepatic cryo and were sacrificed at 1, 2, 6, and 24 h [13].…”

Complement Depletion Enhances Pulmonary Inflammatory Response After Liver Injury

“…[9][10][11] Binding of NF-kB to DNA leads to the production and elaboration of various cytokines (tumor necrosis factor a, interleukin [IL]-1b) and chemokines (IL-8, CINC), which then initiate a similar proinflammatory response in the lung, ultimately producing a mixedcell pulmonary infiltrate and the resultant acute lung injury. 12 Presumably, the initial activation of NF-kB occurs in the hepatic Kupffer cells, which comprise over 80% of the body's tissue macrophages. However, why systemic inflammation occurs with large-volume cryoablation and not other hepatic ablative techniques is uncertain, and the initial stimulus of these NF-kB-dependent mechanisms remains unknown.…”