title: Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm.
abstract: OBJECTIVE
  Sonographically guided radiofrequency ablation is usually one of the most effective treatments for hepatocellular carcinoma. However, the localization of the tumor is a major limiting factor in the use of a sonographically guided procedure. In our experience, sonographic examination with artificial pleural effusion has improved the visualization of hepatocellular carcinomas under the diaphragm. We investigated the safety, benefits, and local efficacy of radiofrequency ablation with artificial pleural effusion.
  
  
  METHODS
  Twenty-five lesions in 23 patients were treated using radiofrequency ablation with artificial pleural effusion, for which 5% glucose solution was injected into the pleural cavity.
  
  
  RESULTS
  Artificial pleural effusion allowed us to visualize the whole tumor on gray-scale sonography in 22 lesions that were not detectable or were poorly visible and to obtain a safer and easier puncture line in 14 lesions. In 23 (92%) of the 25 lesions, artificial pleural effusion was helpful in performing percutaneous radiofrequency ablation. Complete necrosis after radiofrequency ablation was obtained in 22 (88%) of the 25 lesions. During a mean (+/- SD) follow-up period of 10.6 +/- 6.5 months, local recurrence at the ablation site was diagnosed in only one (4.5%) of the 22 lesions. Mild cough in three patients and mild dyspnea in two patients were observed as adverse effects of artificial pleural effusion, but these effects were temporary. Oxygen saturation of the blood during artificial pleural effusion was slightly decreased.
  
  
  CONCLUSIONS
  Radiofrequency ablation with artificial pleural effusion is a safe and beneficial treatment option that offers excellent local control through visualization of hepato-cellular carcinomas under the diaphragm.
authors.affiliation: Second Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Tottori, Japan. masakoda@grape.med.tottori-u.ac.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koda
authors.forename: Masaru
authors.initials: M
authors.lastname: Ueki
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Maeda
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Mimura
authors.forename: Kinya
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsunaga
authors.forename: Manri
authors.initials: M
authors.lastname: Kawakami
authors.forename: Keiko
authors.initials: K
authors.lastname: Hosho
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Murawaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion; D014463:Ultrasonography