title: Diaphragmatic hernia after lung percutaneous radiofrequency ablation: incidence and risk factors.
abstract: OBJECTIVE
  To evaluate diaphragmatic hernias (DH) after percutaneous radiofrequency ablation (PRFA) for basal lung nodules and to detect risk factors.
  
  
  METHODS
  Between January 2009 and December 2012, the presence of DH was retrospectively recorded in all of the patients who underwent PRFA with multitine expandable electrodes for ablation of nodules in the lower lobe. All nodules were classified into three groups according to the location of the tines after deployment relative to the diaphragm: In group 1, the tines were at a distance of >1 cm from the diaphragm; in group 2, at least one tine was in contact with the diaphragm without perforation; and in group 3, at least one tine was perforating the diaphragm.
  
  
  RESULTS
  We recorded 4 cases of DH (3 on the left side, 1 on the right side) in 156 patients (2.3% of procedures). The delay of onset was 7.8 months. DH occurred in groups 2 (n = 1) and 3 (n = 3). Only the 3 cases that occurred on the left side were symptomatic (2 intussusceptions and 1 gastroesophageal reflux) and were surgically repaired. The electrode was positioned in the center of the diaphragm in all cases.
  
  
  CONCLUSIONS
  The central position of the electrode and the contact of at least one tine with the diaphragm after deployment seem to be a risk factor to develop DH.
authors: Department of Interventional Radiology, Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l'Argonne, 33000, Bordeaux, France, nicolasalberti@aol.com.
authors: Nicolas
authors: N
authors: Alberti
authors: Gilbert
authors: G
authors: Ferretti
authors: Xavier
authors: X
authors: Buy
authors: Marie
authors: M
authors: Desjardin
authors: Sultan
authors: S
authors: Al Ammari
authors: Roberto-Luigi
authors: RL
authors: Cazzato
authors: Valérie
authors: V
authors: Monnin-Bares
authors: Dominique
authors: D
authors: Bechade
authors: Gregoire
authors: G
authors: Desolneux
authors: Audrey
authors: A
authors: Michot
authors: Jean
authors: J
authors: Palussiere
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D003287:Contrast Media; D005260:Female; D006548:Hernia, Diaphragmatic / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007472:Iohexol / Q000031:analogs & derivatives; D007479:Iopamidol; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011846:Radio Waves; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D007479:Iopamidol