Diaphragmatic Hernia after Radiofrequency Ablation

Diaphragmatic hernia (DH) is a defect, which can be congenital or can develop later in life. Moreover, chromosomal and genetic abnormalities, environmental exposures, and nutritional deficiencies may be related to the development of congenital DH. In contrast, the risk factors of acquired DH include traumas, such as blunt injuries due to traffic accidents and surgical procedures. We report the case of a 71-year-old man admitted to our gastroenterology department for the treatment of esophageal varices. Four days after the endoscopic treatment, the patient vomited severely and reported severe right upper abdominal pain. He was diagnosed with DH, and surgical fixation was performed. The diaphragmatic injury lesion was located on the estimated needle track of percutaneous radiofrequency ablation, which was performed through the thoracic diaphragm with artificial pleural effusion for hepatocellular carcinoma.

Precise microwave ablation in hepatic neoplasms adjacent to high-risk structures: a prospective pilot study

Objective To evaluate the safety and efficiency of ultrasound (US)-guided precise MWA assisted by artificial pleural effusion and/or ascites in hepatic neoplasms adjacent to high-risk structures based on a 3D preoperative planning system. Methods Twenty-five patients with hepatic neoplasms adjacent to high-risk structures were enrolled. CT images of all patients were reconstructed with 3D visualization software for preoperative planning. The puncture path and needle layout were estimated. US-guided precise MWA assisted by artificial pleural effusion and/or ascites was performed. Patients were followed by clinical and imaging examinations at 3, 6, and 12 months after the MWA. Study outcomes including complications, liver function, AFP level, and ablation lesion volumes were evaluated. Results Thirty-two tumors in 25 patients underwent precise MWA. Except for 4 patients with tumors near the macrovascular, 21 patients received artificial pleural effusion and/or ascites, achieving a complete separation. Based on preoperative 3D planning, patients with tumors near the diaphragmatic dome underwent administration of artificial pleural effusion and ascites, while patients with tumors near the gastrointestinal tract or gallbladder received artificial ascites. Of the 32 tumors, 30 achieved complete ablation in the first MWA session, and 29 achieved conformal ablation with a safe boundary of 0.5-1 cm. No severe complications were observed. Only one tumor exhibited local progression. Moreover, serum levels of ALT, AST and AFP were significantly decreased during the follow-up period. Conclusion Based on the 3D preoperative planning system, US-guided precise MWA assisted by artificial pleural effusion and ascites, is a safe and effective tool to treat hepatic neoplasms adjacent to high-risk structures.