Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis: a case report and review of the literature

Abstract

The management of hepatic abscess formation subsequent to RFA of metastatic hepatic malignancies is not well described. We regard the percutaneous drainage as treatment of pericardial empyema as well as hepatic abscess as less invasive and sufficient, as demonstrated in this case.

Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly

“…Cases of pericardial fistula or hemopericardium have been reported in the literature . Some are well tolerated while others lead to cardiac tamponade and death.…”

Hepatic abscess with hepatobronchial fistula following percutaneous radiofrequency ablation for hepatocellular carcinoma: A case report

“…In the early stages of the tumor, if percutaneous drainage is unable to drain the necrotic tissues due to a lack of tumor tissue liquefaction, antibiotics are the only remaining strategy that may be used to control infection (13). If antibiotic therapy is ineffective, the intrahepatic infection is able to spread and may cause bacteremia (14). In the present case, the diaphragm and adjacent organs were easily invaded by the intrahepatic infectious focus close to the diaphragm.…”

Liver abscess as a complication of microwave ablation for liver metastatic cholangiocarcinoma after bilioenteric anastomosis

“…For different types of liver tumour, the incidence of liver abscess as a complication after intra-arterial chemotherapy to interhepatic cholangiocarcinoma (ICC) was obviously higher than that of hepatocellular carcinoma (HCC) and metastatic liver cancer (25%:7%:0.8%) [4], According to one report about aggressive surgical resection for ICC with bilioenteric anastomosis, anastomosis with subsegmental bile ducts and vascular reconstruction, the incidence of pyogenic liver abscess was as high as 10-13.3% [5]. In addition, pre-existing bilioenteric anastomosis as an independent risk factor for abscess formation was also repeatedly reported after RFA of intrahepatic metastatic cholangiocarcinoma [6][7][8].…”

“…This high incidence of fistula has not been reported to our best knowledge. According to prior studies, the gas and pus in abscess often formed fistula along the coagulated needle track and possibly brought about other abscesses in other positions -for example, the pericardium and pleural cavity [1,8]. In these conditions the inflammation became uncontrollable and even fatal [8].…”