Diaphragmatic Disruption Ahead of Herniation Following Hepatic Radiofrequency Ablation

Abstract

A 48-year-old man with HBV-related cirrhosis was found to have three small hepatocellular carcinomas (HCC) in segment 5, 6 and 8 with a clinical stage of T2N0M0/BCLC stage A. He was treated with percutaneous radiofrequency ablation (RFA) with the aid of artificial pleural effusion to prevent thermal lung injury. However, a delayed diaphragmatic hernia with colon incarceration occurred 11 months later. Diaphragmatic disruption was noted retrospectively 4 months ahead of herniation at the previous image study. It is recommended to handle carefully HCC with RFA at the unfavorable location. Early detection of diaphragmatic injury could be repaired by minimally invasive surgery.