Korean J Radiol.  2009 Aug;10(4):411-415. 10.3348/kjr.2009.10.4.411.

Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

• Yoon DH
• Shim JH
• Lee WJ
• Kim PN
• Shin JH
• Kim KM

• KMID: 1777272
• DOI: http://doi.org/10.3348/kjr.2009.10.4.411

Abstract

Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.

Keyword

Bronchobiliary fistula; Radiofrequency ablation; Hepatocellular carcinoma; Liver abscess; Percutaneous drainage

MeSH Terms

Adult
Biliary Fistula/*etiology/*surgery
Bronchial Fistula/*etiology/*surgery
Carcinoma, Hepatocellular/*surgery
Catheter Ablation/*adverse effects
Drainage/*methods
Female
Humans
Liver Abscess/etiology/surgery
Liver Neoplasms/*surgery

Figure

• 

  Fig. 1 Bronchobiliary fistula in 43-year-old woman. A. Follow-up CT scan obtained immediately after radiofrequency ablation shows complete ablation of hepatocellular carcinoma without direct evidence of diaphragmatic injury, except for small amount of reactive pleural effusion. B. CT scan obtained two months after radiofrequency ablation shows that previously ablated area has become more hypodense, which was identified as abscess (arrow). C. Coronal CT image shows consolidation with abscess in right lower lobe of lung (white arrow) and abscess at radiofrequency ablation site (black arrow), suggestive of focal diaphragmatic defect with communication between lung and liver abscess. D. Contrast material injection via percutaneous needle opacifies liver abscess (thin white arrow), lung abscess (thick black arrow), bronchial tree (thick white arrow) and biliary tree (thin black arrow), confirming presence of bronchobiliary fistula. Patient coughed vigorously when above contrast study was performed. E. Tubography performed with reinsertion of pigtail catheter shows filling of contrast material in right lower lobe of lung (thick arrow), with contrast leakage into right subphrenic space (thin arrow). F. Abdominal CT image obtained three weeks after reinsertion of pigtail catheter shows decreased size of abscess in liver dome (arrow).

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