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Case Report

Hemorrhagic cardiac tamponade after percutaneous laser

ablation of a liver metastasis in segment II

3
1
2
1
Paola Tombesi , Francesca Di Vece , Silvia Rinaldi , Matteo Bertini , Sergio Sartori 1
1 Section of Interventional Ultrasound, Department of Internal Medicine, St. Anna Hospital, 44100 Ferrara, Italy.
2 Anesthesiology Unit, St. Anna Hospital, 44100 Ferrara, Italy.
3 Cardiology Unit, St. Anna Hospital, 44100 Ferrara, Italy.
ABSTRACT
Despite percutaneous laser thermal ablation (LTA) of liver tumors being regarded as a safe technique, major complications
can occur. We report the first case of hemorrhagic cardiac tamponade after LTA of a colorectal metastasis in segment II of
the liver. Unpredictable heat diffusion causing indirect thermal injury to the pericardium with resultant hemorrhagic reaction
was hypothesized as the most likely cause of tamponade. A pericardial drain was emergently placed, 200 mL of bright red
blood were drained, and the patient showed rapid hemodynamic improvement. For lesions located in segment II of the liver
and strictly close to the pericardium, a careful risk/benefit analysis should be made by the multidisciplinary team to identify
the best treatment option, taking into account both effectiveness and complications of each available technique.
Key words: Laser thermal ablation; liver tumors; complications; cardiac tamponade

Corresponding Author:
Prof. Sergio Sartori, Section of Interventional Ultrasound, Department of Internal Medicine, St. Anna Hospital, Via A. Moro 8, Cona, 44100
Ferrara, Italy. E-mail: srs@unife.it
Received: 29-12-2015, Accepted: 22-04-2016

Prof. Sergio Sartori was born on June 22, 1954, and graduated cum laude in 1979. He is specialist
in Gastroenterology and in Clinical Pharmacology, is dealing with interventional ultrasonography
from 1990, and from 2002 is Chief of the Section of Interventional Ultrasound, St. Anna Hospital,
Ferrara, Italy. He is author of more than 246 scientific papers.

INTRODUCTION the ablation volume by using one to four laser fibers,
and thus sparing the normal parenchyma as much as
Percutaneous laser thermal ablation (LTA) of liver malignancies possible. These attributes make LTA an attractive option
is a well established treatment for both primary and for the treatment of nodules in high-risk locations, and/or
secondary liver tumors, with its effectiveness and safety multiple nodules differing in size. [2]
being proven over the last several years. Among all
[1]
thermal treatment modalities, LTA enables the use of Although RFA is the most commonly used ablation
finer needles than radiofrequency ablation (RFA) and technique worldwide, the safety profile reported for LTA is
microwave ablation (MWA), and allows one to tailor comparable to RFA. Mortality rates for both RFA and LTA
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How to cite this article: Tombesi P, Di Vece F, Rinaldi S, Bertini
DOI: M, Sartori S. Hemorrhagic cardiac tamponade after percutaneous
10.20517/2394-5079.2015.68 laser ablation of a liver metastasis in segment II. Hepatoma Res
2016;2:193-6.

© 2016 Hepatoma Research | Published by OAE Publishing Inc. 193