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Figure 1: Oblique sub-costal contrast-enhanced ultrasound scan of the left Figure 3: Oblique subcostal contrast-enhanced ultrasound scan of the left lobe
lobe of the liver, showing an 11 mm metastasis in segment II (large arrows), of the liver performed a few days after laser thermal ablation, showing complete
at close proximity to the diaphragm and pericardium (thin arrows) ablation of the metastasis with a 24 mm × 22 mm avascular area in segment II
(arrows), at a distance of 4 mm from the diaphragm and pericardium (arrowheads)

months prior, without any complication. The procedure
was performed under conscious sedation according to the
[9]
technique proposed by Pacella et al. and modified by Di
[10]
Costanzo et al. by using a diode laser unit (Echolaser,
Elesta srl, Florence, Italy). Under sonographic guidance,
two 21-gauge Chiba needles were placed 12 mm apart
from each other along the anterior border of the tumor.
Subsequently, two bare-tip 300 μm in diameter laser
fibers were introduced through the needles and advanced
until the tip of the fibers was placed 1 cm beyond the
tip of the needle into the deepest part of the tumor.
Eighteen hundred Joule per fiber were delivered in 6
min. Immediately at the conclusion of the procedure, the
patient had a sudden episode of tachycardia to 140 beats/min,
Figure 2: Subxiphoid ultrasound scan showing a large, partially hyperechoic followed by cardiogenic shock. Ultrasound (US) showed
pericardial effusion (arrows) surrounding the cardiac cavities a large amount of partially hyperechoic pericardial
fluid [Figure 2]. Cardiopulmonary resuscitation of the
are less than 1%, and major complication rates range from patient was initiated, and a 6-French pericardial drain
3.3% to 5.1%, and from 1.9% to 3.5%, respectively. [3-5] was emergently placed via the paraxiphoid approach by
an experienced cardiologist. Two hundred mililiter of
Hemorrhagic cardiac tamponade is a very uncommon but bright red blood were drained, and the patient showed
potentially fatal complication that has been sporadically rapid hemodynamic improvement. After hemodynamic
reported during RFA of nodules located in the left lobe stabilization, abdominal artery angiography was
of the liver, close to the diaphragm and pericardium. [6-8] performed in order to exclude vascular damage to the
diaphragmatic arteries and left hepatic artery. No vascular
We report the first case of acute hemorrhagic cardiac injury was observed, and the patient was admitted to the
tamponade occurring after LTA of a small liver metastasis cardiology unit. He remained asymptomatic, the drainage
from colorectal cancer in segment II. catheter was removed, and he was discharged after 5
days. Contrast-enhanced US (CEUS) performed before the
CASE REPORT discharge from the hospital showed complete ablation
of the metastasis with a 24 mm × 22 mm avascular
This is a retrospective report of a clinical case, and was area in segment II [Figure 3]. No lesion or injury of the
exempted from Institutional Review Board approval. The diaphragm was observed. Echocardiography showed
patient gave his written informed consent prior to the resolution of the pericardial effusion.
interventional procedure.
Clinical follow up was performed weekly for the first month
A 41-year-old man underwent LTA of a small, 11 mm colorectal after discharge, and no further complication was observed.
metastasis in segment II of the liver, in close proximity
to the diaphragm and pericardium [Figure 1]. Four DISCUSSION
liver metastases in the right lobe and one metastasis in Acute cardiac tamponade is an extremely infrequent,
segment III had been successfully ablated by LTA three
194 Hepatoma Research | Volume 2 | July 1, 2016