Contrast‐Enhanced Sonographically Guided Thermal Ablation for Treatment of Solid‐Organ Hemorrhage

Abstract

The purpose of this series was to preliminarily evaluate the use of contrast‐enhanced sonographically guided percutaneous thermal ablation in the evaluation and treatment of solid‐organ bleeding by retrospectively analyzing 6 cases observed in clinical practice. Six patients who underwent contrast‐enhanced sonographically guided thermal ablation for treatment of solid‐organ bleeding (5 in liver and 1 in spleen) from December 2005 to August 2012 were included in this series. Clinical information, contrast‐enhanced sonograms before and after ablation, and the ablation method were retrospectively collected and analyzed. In 5 of the 6 patients, the location of the bleeding lesion was clearly seen. Hemostasis was successfully achieved in 4 of these 5 patients: 1 by radiofrequency ablation and 3 by microwave ablation. Ablation failed to achieve hemostasis in 1 patient who had postbiopsy splenic arterial bleeding because the bleeding vessel was a thick branch of the splenic artery. In the sixth remaining patient, who had bleeding after liver biopsy, hemostasis failed because contrast‐enhanced sonography did not precisely locate the bleeding lesion; hence, the ablation zone did not cover the whole lesion. Contrast‐enhanced sonographically guided ablation can be an alternative choice for treating solid‐organ bleeding because of its effectiveness and minimal invasiveness. However, it should be carefully investigated for those in whom the bleeding lesion cannot be located by contrast‐enhanced sonography and in those who have bleeding in a large vessel.

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

“…A total of 12 studies (all case series) fall into this miscellaneous section, which includes 4 categories of CEUS assisted procedures: (1) US‐guided abscess drainage; (2) US‐guided percutaneous nephrostomy; (3) US‐guided biliary interventions; and (4) hepatic and splenic hemorrhage. In the first 3 categories, a diluted contrast solution (ie, 0.1 mL of SonoVue in 20 mL of saline) is injected directly in the catheter or needle to visualize the exact location of the cavity or tissue around the catheter or needle tip: so‐called intracavitary CEUS.…”

“…Intravenous use of CEUS to detect and guide percutaneous treatment of splenic and hepatic hemorrhage or lesions after trauma or biopsy has been reported in 4 series, but only in 2 series was another imaging technique (CT) used as the reference standard, which resulted in a detection rate of 100% in both . Three of the studies reported on CEUS‐guided percutaneous treatment of hemorrhage . In 1 study, bleeding successfully resolved with thermal ablation in 4 of 5 cases .…”

“…Three of the studies reported on CEUS‐guided percutaneous treatment of hemorrhage . In 1 study, bleeding successfully resolved with thermal ablation in 4 of 5 cases . In the other 2 studies, injection of hemocoagulase in 1 or 2 attempts was reported as successful in 100% in series of 88 and 6 cases, respectively .…”

Thermal ablation of hepatocellular carcinoma in patients with abnormal coagulation function

“…Among the currently used imaging methods, ultrasound is relatively more suitable for examination during ablation, and studies have shown that CEUS is sensitive to detect trauma-caused bleeding in solid organs with a similar accuracy as enhanced computerised tomography [30,31]. Thus, CEUS is effective for detecting needle tract bleeding during ablation.…”

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study

“…Although ultrasound and diagnostic peritoneal lavage have high sensitivity in the detection of complications of abdominal injuries, the diagnostic methods have low value in the absence of the free flow of fluid. Even a CT scan has low sensitivity in detecting abdominal injuries, including mesentery, intestines, pancreas, and diaphragm injuries ( 22 – 24 ). In addition, emergency physicians do not have clear criteria for early discharge of patients with blunt abdominal trauma before using a CT scan ( 25 ).…”