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Risk and protective factors of higher-grade intrapulmonary hemorrhage in patients undergoing percutaneous computed

Yunxin Li1, Yanyan Xu2, Hongxiang Feng3

  • 1Department of Radiology, Yantaishan Hospital, Yantai, China.

Journal of Thoracic Disease
|October 29, 2025
PubMed
Abstract

Insights

Repeat microcoil insertion during CT-guided localization for VATS increases hemorrhage risk. Factors like pneumothorax and larger nodule size are protective against bleeding.

Area of Science:

  • Thoracic Surgery
  • Interventional Radiology
  • Pulmonary Medicine

Background:

  • Computed tomography (CT)-guided microcoil localization is used before video-assisted thoracoscopic surgery (VATS).
  • This procedure carries a risk of intrapulmonary hemorrhage.
  • Identifying predictors of hemorrhage is crucial for patient safety.

Purpose of the Study:

  • To identify independent predictors of higher-grade intrapulmonary hemorrhage (≥ Grade 2) after CT-guided microcoil localization.
  • To optimize patient selection and procedural planning for VATS.

Main Methods:

  • Retrospective analysis of 432 patients undergoing microcoil localization prior to VATS (2016-2020).
  • Radiological grading of hemorrhage severity (Grade 0-4).
  • Univariate and multivariate logistic regression to identify significant factors (P<0.05).

Main Results:

  • Intrapulmonary hemorrhage occurred in 37.27% of procedures; higher-grade hemorrhage in 9.49%.
  • Repeat insertion was the only significant risk factor for higher-grade hemorrhage (OR=9.712, P<0.001).
  • Protective factors included pneumothorax, larger nodule size (>5 mm), longer pleura-microcoil distance (>20-30 mm), and lower lung radiodensity (≤-850 HU).

Conclusions:

  • Repeat microcoil insertion is a significant risk factor for intrapulmonary hemorrhage during CT-guided localization.
  • Pneumothorax, larger nodule size, increased pleura-microcoil distance, and lower lung density appear protective.
  • Findings support risk-stratified patient management for CT-guided microcoil localization before VATS.
Keywords:
Intrapulmonary hemorrhagecomputed tomography-guided (CT-guided)localizationprotective factorrisk factor

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