Percutaneous radiofrequency ablation of hepatocellular lesions in segment II of the liver: a risk factor for cardiac tamponade

Hemorrhagic cardiac tamponade after percutaneous laser ablation of a liver metastasis in segment II

“…To date, 4 cases of cardiac tamponade have been reported in literature as a complication of percutaneous thermal ablation. [6][7][8] In all cases, the complication occurred after RFA of liver nodules performed by using expandable radiofrequency needles. The authors hypothesized two possible explanations for the occurrence of cardiac tamponade.…”

“…The authors hypothesized two possible explanations for the occurrence of cardiac tamponade. [6][7][8] First, the exact position of expandable RFA needles is more complicated to track at any time than that of the non-expandable RFA probes, MWA antennas, or LTA fibers. Therefore, a RFA hook could have inadvertently been placed in the diaphragm or in the pericardium, causing direct injury to these structures.…”

“…Indeed, in 2 cases the presence of a RFA hook in the pericardial fat was documented by computed tomography. [8] Secondly, in some unclear circumstances, the distribution of heat in vivo may be unpredictable, and the pericardium can become injured by heat conduction. Indeed, tissues exposed to elevated temperature may react with an inflammatory or hemorrhagic response, and such an injury has been observed in other viscera such as the gall bladder or colon.…”

“…First, in all four cases previously reported in literature as well as in our patient, such a lifethreatening complication occurred with tumors located in segment II of the liver. [6][7][8] Although cardiac tamponade is an extremely infrequent complication of thermal ablation and is more likely to occur when expandable RFA needles are used, [6][7][8] our experience shows that it may also occur with other theoretically safer techniques, such as LTA. Therefore, tumor location in segment II must be considered a major risk factor for cardiac tamponade during ablation procedures regardless of technique used, and according to Moumouh et al, [6] we wonder: "was percutaneous thermal ablation the best therapeutic option in this case?"…”

“…[3][4][5] Hemorrhagic cardiac tamponade is a very uncommon but potentially fatal complication that has been sporadically reported during RFA of nodules located in the left lobe of the liver, close to the diaphragm and pericardium. [6][7][8] We report the first case of acute hemorrhagic cardiac tamponade occurring after LTA of a small liver metastasis from colorectal cancer in segment II.…”