Interventional Radiologists at MedStar Georgetown University Hospital use minimally invasive techniques with image guidance to diagnose and treat many lung diseases. Interventional Radiologists are involved in the diagnosis and treatment of lung cancer with procedures such as percutaneous needle biopsies, fiducial placement for radiation therapy, and ablation therapies. They also primarily treat other lung diseases such as pulmonary arteriovenous malformations using embolization techniques. Blood clots in the legs and lungs can be a source of significant adverse consequences and interventional radiologists may reduce/remove the clot using catheter-directed thrombolysis or minimize the risk of disease by the placement/removal of IVC filters. They may also aid in the removal of fluid from around the lung by placing short term or long term catheters in the pleural space.
For further information or to schedule a consultation with an interventional oncologist, please contact the interventional radiology department at 202-444-5478.
Pulmonary Arteriovenous Malformations (AVMs)
Pulmonary arteriovenous malformations (AVMs) are rare lesions with significant clinical complications. An abnormal connection between arteries and veins in the lung may lead to trouble breathing (i.e., hypoxia), bleeding or the clogging of blood vessels from the abnormal blood flow which may lead to the development of stroke or brain abscess. Interventional radiologists can often treat these abnormalities without surgery, using minimally invasive techniques, to block the abnormal flow of blood through the AVM.
Diagnosis of lung masses may be performed using needle biopsy using moving X-ray technique (fluoroscopy), computed tomography (CT), ultrasound or magnetic resonance (MR) to guide the procedure. Needle biopsy is typically an outpatient procedure with very infrequent complications. Depending on whether the biopsy is taken to diagnose the lung mass, guide treatment or as part of a clinical research trial, large core needle biopsy or fine needle aspiration samples may be taken. Image guidance reduces the risk of injury to nearby structures (such as blood vessels and vital organs). In addition, recovery times, pain, scarring and complications associated with surgery are reduced.
Treatment of lung cancer may be complex and involve several subspecialties. Interventional Radiologists may be involved in the diagnosis of lung cancer and in guiding treatment/research if subsequent needle biopsies are necessary. Lung cancer may also be treated using Cyberknife therapy (i.e., directed/focused radiation) and Interventional Radiologists may help focus the radiation on the lung mass by placing small markers in and around the lung mass (i.e., fiducials) in a procedure similar to needle biopsy. Interventional Radiologists may also guide targeted treatment of lung cancer using variety of methods including radiofrequency ablation (RFA) which is a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing nearby healthy lung tissue. Similar to RFA, cryoablation may be used to kill the tumor cells by freezing them. Finally, chemoembolization may be when there is too much tumor or tumor is in a poor location to treat with RFA or cryoablation.
Left untreated, clot within the deep veins (i.e., a deep vein thrombosis (DVT)) can lead to several adverse consequences. The most concerning is a life-threatening event called pulmonary embolism (PE) which occurs when the clot breaks free and travels to the lungs. PE can have minor consequences where the patient doesn’t feel the effects (i.e., is asymptomatic) or PE can be major and lead to death. Interventional Radiologists offer a number of treatments for the treatment and prevention of DVT and PE. Many PE patients are treated with blood thinners (e.g., heparin, Coumadin) to keep more clot from forming while their body naturally breaks down the existing clot over the course of weeks/months. For patients who may be at high risk for use of blood thinners or who may not be able to tolerate reduced blood flow to the lungs, use of a filtration device, called an Inferior Vena Cava (IVC) filter may be considered. Using minimally invasive techniques, an Interventional Radiologist may place a device in a large vein near the heart to trap clot that may break off from the DVT before it goes to the lungs. Interventional Radiologists may also offer minimally invasive methods to break down clot that has already formed by injecting “clot-busting” drugs (e.g., TPA) and mechanically breaking down/removing clot that is in the lung blood vessels (pulmonary arteries) in a procedure called catheter-directed pharmacomechanical thrombolysis (CDT). This procedure is generally considered for patients who have significant PE or are at risk from the long term consequences of PE. Interventional Radiologist may also perform CDT in situations that are not life-threatening to reduce longer term complications that may arise (e.g., post-thrombotic syndrome, pulmonary hypertension).
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For further information or to schedule a consultation with an interventional oncologist, please contact the interventional radiology department at