Korean J Gastroenterol.  2013 Sep;62(3):174-178. 10.4166/kjg.2013.62.3.174.

A Case of Diaphragmatic Hernia Induced by Radiofrequency Ablation for Hepatocellular Carcinoma

• Kim JS
• Kim HS
• Myung DS
• Lee GH
• Park KJ
• Cho SB
• Joo YE
• Choi SK

• KMID: 1707201
• DOI: http://doi.org/10.4166/kjg.2013.62.3.174

Abstract

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.

Keyword

Hepatocellular carcinoma; Catheter ablation; Diaphragmatic hernia

MeSH Terms

Carcinoma, Hepatocellular/*diagnosis/*radiotherapy/therapy
Catheter Ablation/*adverse effects
Chemoembolization, Therapeutic
Hernia, Diaphragmatic/*etiology/surgery
Humans
Liver Cirrhosis, Alcoholic/complications/*diagnosis
Liver Neoplasms/*diagnosis/*radiotherapy/therapy
Magnetic Resonance Imaging
Male
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1. Hepatocellular carcinoma in hepatic dome (segment 8). (A) Axial MRI section showing a slightly enhanced nodule in the hepatic dome (arrow) during the arterial phase. (B) Coronal T1 weighted image showing a hypointense nodule in the hepatic dome (arrow).

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  Fig. 2. Abdomen CT findings. (A) Coronal abdomen CT revealed about a 2.0 cm sized defect (arrowhead) of the diaphragm adjacent to the lesion (arrow) that was ablated. (B) Coronal abdomen CT showed herniation of mesenteric fat and blood vessels (arrow).

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  Fig. 3. Twenty-two months after radiofrequency ablation. (A) Chest X-ray showing a large amount of pleural fluid and loops of bowel (arrow) in the right pleural cavity. (B) Coronal chest CT image showing about a 4.0 cm sized defect of the diaphragm (arrow-head) and herniation of the large intestine (arrow) in the right pleural cavity.

Reference

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