RFA Liver Complications (CT)

Case courtesy of our radiology website partner, RiT.
Complications of Radiofrequency Ablation of Liver Tumors: Hematoma. Axial CT image before radiofrequency ablation of a liver metastasis (star) is shown.

Vascular complications of RFA

1. Portal vein thrombosis (0.7%)
2. Subcapsular hematoma (0.7%)
3. Hepatic vein thrombosis
4. Hepatic infarction

Facts

* Thrombosis of vessel occurs as a result of 'heat-sink' effect to the flowing blood. Smaller caliber vessels are prone to thrombose due to thermal damage from RF ablation
* On US, or CT, thrombosis is visualized as filling defects
* Hepatic parenchyma may show segmental enhancement peripheral to the affected veins
* Most thrombosis is self limited
* Subcapsular hematoma usually is related to placement of electrodes or underlying coagulopathy.

Reference:
Akahane M, Koga H, Kato N, et al. Complications of percutaneous radiofrequency ablation for hepatocellular carcinoma: imaging spectrum and management. Radiographics 2005; 25:S57-S68.