Diaphragmatic necrosis after radiofrequency ablation of hepatocellular carcinoma: A successful surgical repair

Kanso, Frédéric; Nahon, Pierre; Blaison, D; Trinchet, Jean–Claude; Beaugrand, Michel; Séror, Olivier; Martinod, Emmanuel

doi:10.1016/j.clinre.2012.09.011

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…Current studies link diaphragmatic injury in HCC patients primarily to radiofrequency ablation, attributed to thermal damage or penetrant injury [ 13 , 14 ]. As for the treatment of the present case, while target therapy for HCC lacks known complications regarding diaphragmatic injury, radiotherapy has been documented to induce tissue damage and even lead to fistulas and perforations [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

Chen,

Lai,

et al. 2024

Medicina

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Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver’s unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.

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Section: Discussionmentioning

confidence: 99%

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

Chen,

Lai,

et al. 2024

Medicina

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“…Development of intractable pleural effusion during the follow up period after RFA is another possible sign of diaphragm perforation[ 16 , 22 ]. In our cases, intractable plural effusion before the onset of diaphragmatic herniation was present in 3 of our 6 cases.…”

Section: Discussionmentioning

confidence: 99%

Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma

Nagasu

Okuda

Kuromatsu

et al. 2017

WJGS

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We review 6 cases of diaphragmatic perforation, with and without herniation, treated in our institution. All patients with diaphragmatic perforation underwent radiofrequency ablation (RFA) treatments for hepatocellular carcinoma (HCC) performed at Kurume University Hospital and Tobata Kyoritsu Hospital. We investigated the clinical profiles of the 6 patients between January 2003 and December 2013. We further describe the clinical presentation, diagnosis, and treatment of diaphragmatic perforation. The change in the volume of liver and the change in the Child-Pugh score from just after the RFA to the onset of perforation was evaluated using a paired t-test. At the time of perforation, 4 patients had herniation of the viscera, while the other 2 patients had no herniation. The majority of ablated tumors were located adjacent to the diaphragm, in segments 4, 6, and 8. The average interval from RFA to the onset of perforation was 12.8 mo (range, 6-21 mo). The median Child-Pugh score at the onset of perforation (8.2) was significantly higher compared to the median Child-Pugh score just after RFA (6.5) (P = 0.031). All patients underwent laparotomy and direct suture of the diaphragm defect, with uneventful post-surgical recovery. Diaphragmatic perforation after RFA is not a matter that can be ignored. Clinicians should carefully address this complication by performing RFA for HCC adjacent to diaphragm.

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“…Although often associated with lower morbidity compared to extensive open surgery, these therapies can cause complications related to thermal damage of surrounding tissues, including skin necrosis [27, 28]. Acute myonecrosis can also occur, and has been reported to affect the diaphragm after radiofrequency ablation of hepatocellular carcinoma at the dome [29]. Embolization has also been implicated in cases of acute myonecrosis, principally due to non-target embolization of arteries supplying skeletal muscle [30], or as a complication of embolization to control hemorrhage in severe pelvic fractures [31, 32].…”

Section: Discussionmentioning

confidence: 99%

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

et al. 2016

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Objective To determine etiologies of myonecrosis in oncology patients and to assess interobserver variability in interpreting its MRI features. Materials and Methods Pathology records in our tertiary cancer hospital were searched for proven myonecrosis, and MRIs of affected regions in those patients were identified. MRI reports that suggested myonecrosis also were identified. Each MRI was reviewed independently by two of six readers to assess anatomic site, size, and signal intensities of muscle changes, and presence of the previously reported stipple sign (enhancing foci within a region defined by rim enhancement). The stipple sign was assessed again, weeks after a training session. Cohen kappa and percent agreement were calculated. Medical records were reviewed for contemporaneous causes of myonecrosis. Results MRI reports in 73 patients suggested the diagnosis of myonecrosis; pathologic proof was available in another two. Myonecrosis was frequently associated with radiotherapy (n=34 (45%) patients)); less frequent causes included intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, and diabetes. Myonecrosis usually involved lower extremity, pelvis, and upper extremity; mean size was 13.0 cm. Stipple sign was observed in 55–95% of patients at first assessment (k=0.09–0.42; 60–80% agreement) and 55–100% at second (k=0.0–0.58; 72–90% agreement). Enhancement surrounded myonecrosis in 55–100% patients (k=0.03 – 0.32; 58–70% agreement). Conclusion Myonecrosis in oncology patients usually occurred after radiotherapy, and less commonly after intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, or diabetes. Although interobserver variability for MRI features of myonecrosis exists (even after focused training), a combination of findings facilitates diagnosis and conservative management.

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Diaphragmatic necrosis after radiofrequency ablation of hepatocellular carcinoma: A successful surgical repair

Cited by 9 publications

References 18 publications

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

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