Radiofrequency Ablation of Hepatic Lesions: A Review

Venkataramu N. Krishnamurthy, MD; V. Javier Casillas, MD; Lina Latorre, MD

Disclosures

Appl Radiol. 2003;32(10) 

In This Article

Complications of RF Ablation

The incidence of clinically relevant complications following percutaneous RF ablation is low (2% to 7%).[53,54] Although significant pain requiring IV narcotics is universal in all patients immediately after the procedure, persistent severe pain lasting more than 1 week is very rare. Ablation-induced injury to the diaphragm, gallbladder, intestines, liver capsule, and major portal veins are some of the causes of extended pain. These patients should be evaluated carefully, and any additional causes for acute abdominal pain should also be excluded.

Tumor ablation syndrome is another complication that results from the release of mediators of the inflammatory response due to ablation-induced cell death. The severity of the syndrome is dependent on the volume of tissue ablated. Smaller ablations result in low-grade fever (<38.8°C), malaise and leukocytosis starting about 3 to 4 days after the procedure and lasting for 1 week to 10 days. Larger ablations result in more severe symptoms of high-grade fever, nausea, vomiting, and lethargy. The symptoms can begin as early as day 1 and persist for 2 to 3 weeks. The treatment for ablation syndrome is primarily supportive, including antipyretics and hydration. The most important differential diagnosis is abscess at the site of ablation or septicemia. If infection is suspected, blood cultures should be performed and IV broad-spectrum antibiotics given. CT scanning may demonstrate gas at the ablation site, which need not necessarily signify abscess, since gas may be seen routinely following ablation without infection. Therefore, drainage of the ablation cavity that is suspected to be an abscess is purely a clinical decision.

Other reported complications are rare and include bleeding, injury to the bile duct (resulting stricture or biliary fistula) (Figure 7), pleural and lung injury causing pneumothorax and pleural effusion, gallbladder injury causing cholecystitis, and colon and intestinal injury causing ischemic bowel. Rarely, tumor seeding in the tract of the needle may be seen (Figure 8). But proper tract ablation can eliminate this complication (Figure 9). Vascular complications are hepatic artery pseudoaneurysm and arteriovenous fistula. Grounding-pad-related burns are also reported occasionally.[12] Procedure-related mortality is very rare (<1%).[25]

Biliary stricture after radiofrequency (RF) ablation. A 50-year-old woman, status post-right hepatectomy for metastatic colon carcinoma, underwent percutaneous RF ablation of a left-lobe metastasis. She returned with jaundice. (A) Follow-up CT scan shows 2 large hypodense areas of ablation in the left lobe. (B) Percutaneous transhepatic cholangiogram shows biliary dilatation with stricture of main left hepatic duct. (C) Cholangioplasty was performed and internal external biliary drainage catheter was placed.

Biliary stricture after radiofrequency (RF) ablation. A 50-year-old woman, status post-right hepatectomy for metastatic colon carcinoma, underwent percutaneous RF ablation of a left-lobe metastasis. She returned with jaundice. (A) Follow-up CT scan shows 2 large hypodense areas of ablation in the left lobe. (B) Percutaneous transhepatic cholangiogram shows biliary dilatation with stricture of main left hepatic duct. (C) Cholangioplasty was performed and internal external biliary drainage catheter was placed.

Biliary stricture after radiofrequency (RF) ablation. A 50-year-old woman, status post-right hepatectomy for metastatic colon carcinoma, underwent percutaneous RF ablation of a left-lobe metastasis. She returned with jaundice. (A) Follow-up CT scan shows 2 large hypodense areas of ablation in the left lobe. (B) Percutaneous transhepatic cholangiogram shows biliary dilatation with stricture of main left hepatic duct. (C) Cholangioplasty was performed and internal external biliary drainage catheter was placed.

Status post-CT-guided radiofrequency ablation of a right liver hepatoma. Three-month follow-up CT scan shows tumor seeding in the needle tract, seen as a small soft-tissue density nodule in the subcutaneous tissue of lateral abdominal wall.

(A) A 67-year-old woman, status post-right hepatectomy for colorectal metastasis. CT scan shows a low-attenuation metastatic lesion in the left lobe of the liver. (B) A 24-hour postradiofrequency ablation CT scan shows complete tumor necrosis. Note the linear hypodensity extending anteriorly, which corresponds to the tract ablation.

(A) A 67-year-old woman, status post-right hepatectomy for colorectal metastasis. CT scan shows a low-attenuation metastatic lesion in the left lobe of the liver. (B) A 24-hour postradiofrequency ablation CT scan shows complete tumor necrosis. Note the linear hypodensity extending anteriorly, which corresponds to the tract ablation.

Complications are also seen when general anesthesia is used. Open procedures (RF ablation at laparotomy and laparoscopy) have additional increased morbidity and mortality related to abdominal surgery and increased length of hospitalization.

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