Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis.
A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures.
Francica
G
G
Divisione di Gastroenterologia, Ospedale Cardinale Ascalesi, Naples, Italy. giampierofrancica@libero.it
Marone
G
G
Solbiati
L
L
D'Angelo
V
V
Siani
A
A
D000208:Acute Disease; D017115:Catheter Ablation / Q000009:adverse effects*; D005704:Gallbladder / Q000000981:diagnostic imaging; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging / Q000209:etiology*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006431:Hemobilia / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D013274:Stomach Neoplasms / Q000473:pathology; D018084:Ultrasonography, Interventional; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*