Contrast-enhanced sonography with perflubutane revealing active bleeding as a complication of radiofrequency ablation
✍ Scribed by Tomomitsu Matono; Masahiko Koda; Yoshikazu Murawaki
- Publisher
- John Wiley and Sons
- Year
- 2012
- Tongue
- English
- Weight
- 283 KB
- Volume
- 55
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Contrast-Enhanced Sonography with Perflubutane
Revealing Active Bleeding as a Complication of Radiofrequency Ablation A 73-year-old woman with chronic hepatitis C and hepatocellular carcinoma (HCC) was hospitalized for radiofrequency ablation (RFA). Laboratory test results showed the following: platelet count, 62,000/mm 3 ; prothrombin time, 12 seconds; albumin, 4.4 g/dL; bilirubin, 0.8 mg/dL; alpha-fetoprotein, 8.5 ng/mL; and des-gamma-carboxy prothrombin, 11 mAU/mL. Gadoxetic acid-enhanced magnetic resonance imaging demonstrated a low-intensity area in the hepatobiliary phase in segment VIII. Contrast-enhanced ultrasonography (CEUS) showed hyperenhancement in the vascular phase with hypoenhancement in the postvascular phase. Aspiration biopsy revealed well-differentiated HCC. We performed CEUS-guided RFA with a 2-cm Cool-tip RFA system (Radionics, Burlington, MA) through an intercostal space. No abnormalities in the chest wall were found before RFA and the patient had no complaints, except for mild pain during ablation. Increased thickness of the chest wall was found during RFA. Immediately after ablation, we performed CEUS with perflubutane and identified linear extravasation of microbubbles along the needle tract in the vascular phase (Fig. 1A). After 5 and 10 minutes, we reinjected perflubutane and could find no extravasations of microbubbles (Fig. 1B). Enhanced computed tomography (CT) demonstrated a hemorrhage in the chest wall (Fig. 1C) and a small amount of intraperitoneal hemorrhage on the hepatic surface (Fig. 1D), but no active bleeding. We speculated that an intercostal vessel had been injured by the electrode, with spontaneous resolution of the hemorrhage.
Hemorrhages resulting from RFA occur in 0.5% of cases. 1 In our case, bleeding from an intercostal vessel into the chest wall was clearly detected on CEUS. CEUS is reported to show 100% sensitivity and 100% specificity for the detection of active bleeding. 2 We could repeatedly and in real time confirm continued