Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma

Abstract

Rationale:Radiofrequency ablation (RFA) is a safe and effective local treatment modality with a low complication rate and is commonly used to treat hepatocellular carcinoma (HCC). The clinical outcome of RFA may be closely related to the location, size, and shape of index tumors, and major complications, including hemorrhage, liver abscess, infarction, visceral organ perforation, hemothorax, pneumothorax, tumoral seeding, and hepatic failure. Cardiac tamponade is a rare and serious life-threatening complication associated with RFA. To date, a review of the medical literature reported 5 cases of cardiac tamponade after RFA for HCC. Herein, we report another case of cardiac tamponade after RFA for HCC in a 56-year-old man.Patient concerns:He had suffered from liver cirrhosis due to alcohol abuse. He had chronic obstructive pulmonary disease. Magnetic resonance imaging showed a 3.0-cm exophytic subcapsular HCC in segment IVa of left hepatic lobe. As the patient was at high risk for surgery because of poor lung function, RFA was selected as the treatment of choice. The index tumor was located in the vicinity of the diaphragm and colon. During RFA procedure, thermal injury to the adjacent diaphragm and colon was minimized by introducing artificial ascites. Bleeding or tumoral seeding was prevented by ablating the electrode track during electrode retraction.Diagnosis:Two hours after RFA, the patient presented with dyspnea, chest discomfort, and low blood pressure (80/60 mm Hg), suggesting cardiac tamponade. Immediate follow-up contrast-enhanced computed tomography image depicted the slightly high attenuated hemopericardium. Transthoracic echocardiography (TTE) showed a moderate amount of pericardial effusion with tamponade and a large hematoma.Interventions:Under fluoroscopy and portable echocardiography guidance, a cardiologist immediately inserted a 7-French pigtail catheter into the pericardial space and collected more than 200 cc of bloody pericardial fluid.Outcomes:After pericardiocentesis, the patient's symptoms and hemodynamic status were dramatically improved. Follow-up TTE showed scanty amount of pericardial effusion and the drainage catheter was removed. The patient was discharged.Lessons:When treating HCC in the left lobe (especially segments II and IVa), attention should be paid to cardiac tamponade. The early diagnosis and immediate treatment of cardiac tamponade may increase the chance of cure.

Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery

“…Causes of pericardial tamponade can be divided into surgical (mostly acute onset) and medical (mostly chronic). Cardiac tamponade in the perioperative period may develop after cardiac surgery, percutaneous cardiac interventions, central venous cannulations, laparoscopic surgery, radiofrequency ablation for hepatocellular carcinoma or in patients presenting for aortic dissection surgery 100–104 …”

“…Cardiac tamponade in the perioperative period may develop after cardiac surgery, percutaneous cardiac interventions, central venous cannulations, laparoscopic surgery, radiofrequency ablation for hepatocellular carcinoma or in patients presenting for aortic dissection surgery. [100][101][102][103][104] Today, cardiac tamponade is recognised as an essential diagnosis to exclude as a reversible cause during CPR.…”

Vascular complications related to image-guided percutaneous thermal ablation of hepatic tumors

“…Hemorrhagic cardiac tamponade is an extremely rare but potentially fatal complication that can be successfully treated if promptly detected. To date, about six cases have been reported in the literature (21). Tumors located in the left lobe in close proximity to the pericardium, namely in segment II and IVa, are considered a pertinent risk factor for this complication (21) (Fig.…”

“…To date, about six cases have been reported in the literature. 21 Tumors located in the liver’s left lobe near the pericardium (namely in segments II and IVa) are considered pertinent risk factors for this complication ( Figure 10 ). 21 Emergency pericardiocentesis (with the placement of a drainage catheter into the pericardial space) should be performed if the post-procedure hemodynamic parameters and imaging favor a pericardial effusion.…”

Kangxianruangan granule‑containing serum mediated inhibition of hepatic oval cell differentiation into hepatocellular carcinoma cells via the Wnt‑1/β‑catenin signaling pathway

“…Epidemiological studies have revealed that HCC displays a unique background of chronic liver injury ( 4 ). Globally, 80% of liver cancer is caused by occult hepatitis and viral infection-induced chronic hepatitis ( 5 ). The resulting liver inflammatory response and the development of liver fibrosis and liver nodules are directly related to the formation of liver cancer ( 6 ).…”