I

HP

C*

At(wdwdgsspsd

1

2

mage of the Month

epatic Infarction and Hepatic Artery Pseudoaneurysm Witheritoneal Bleeding After Radiofrequency Ablation for Hepatoma

HIAO–HSIUNG CHUANG,* CHIUNG–YU CHEN,* and HONG–MING TSAI‡

Department of Internal Medicine and ‡Department of Radiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan

p

1eatcb

trRan

75-year-old man with liver cirrhosis, Child–Pughgrade A, received percutaneous radiofrequency abla-

ion (RFA) for a 2.5-cm hepatoma in right lobe of the liverFigure A). The procedure went smoothly, and the patientas discharged 2 days later. On the 7th day post-RFA, heeveloped progressive right abdominal pain. On arrival, heas hemodynamically stable and had right abdominal ten-erness. An abdominal sonogram disclosed massive echo-enic materials and fluid accumulation under the liver cap-ule and within the peritoneum. A computed tomographycan further showed a massive right hepatic infarction, aseudoaneurysm (arrow) adjacent to the previous ablationite, and much fresh blood in the peritoneum and gallblad-

er (Figure B). Ten hours after arrival, his systolic blood a

2004;135:460–461.

ressure fell to 85 mm Hg, and hemoglobin decreased from

1.9 to 8.3 g/dL. Emergency angiography revealed contrastxtravasating from the right hepatic artery (arrow) with pseudo-neurysm formation (Figure C). The bleeding was stopped byranscatheter arterial embolization with a metallic coil. He re-eived antibiotics and needle aspiration of the peritoneum for oldlood twice, and he was discharged 16 days later.RFA can damage vascular structures, causing occlusion,

hrombus, or bleeding, and rarely causes hemothorax, arte-iovenous fistula, or hemobilia.1,2 In this presented case,FA caused vessel occlusion with massive hepatic infarctionnd pseudoaneurysm with delayed bleeding into the perito-eum and biliary tract. Angiography allows early detection

nd transcatheter embolization of the bleeding artery.

References. Curley SA, Marra P, Beaty K, et al. Early and late complication after radiofrequency ablation of malignant liver tumors in 608 patients. Ann

Surg 2004;239:459–463.. Enne M, Pacheco-Moreira LF, Cerqueira A, et al. Fatal hemobilia after radiofrequency thermal ablation for hepatocellular carcinoma. Surgery

© 2005 by the American Gastroenterological Association1542-3565/05/$30.00

PII: 10.1053/S1542-3565(05)00159-X

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:xxiii