Research Article

Recurrent hydrothorax due to diaphragmatic perforation post hepatocellular carcinoma radiofrequency ablation: A case report

Laia Aceituno*, Alba Prió, Fernando L Ascanio, Xavier Serres-Créixams, Beatríz Mínguez, Joan Genescà, Lluís Castells and Ares A Villagrasa

Published: 02/15/2021 | Volume 5 - Issue 1 | Pages: 013-015


Radiofrequency ablation is one of the most commonly used therapies for potentially curative small hepatocellular carcinoma. Although radiofrequency is usually a safe procedure, severe and potentially fatal complications can happen. This is a case of a 72 years old woman with cirrhosis secondary to Metabolic Associated Fatty Liver Disease (MAFLD), who presented recurrent hydrothorax after treating hepatocellular carcinoma (HCC) with radiofrequency ablation (RFA), and in which diaphragmatic perforation was subsequently diagnosed. We reviewed the differential diagnosis and management in a pleural effusion after a radiofrequency procedure. Although diaphragmatic perforation is an uncommon complication after RFA procedure, this case aims to help clinicians being aware of non-habitual complications.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001026 Cite this Article


  1. Banini BA, Alwatari Y, Stovall M, Ogden N, Gershman E, et al. Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence-Based Review and Guidance. Hepatology. 2020; 72: 1851-1863. PubMed:
  2. Galle PR, Forner A, Llovet JM. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018; 69: 182-236. PubMed:
  3. De Baère T, Risse O, Kuoch V, Dromain C, Sengel C, et al. Adverse events during radiofrequency treatment of 582 hepatic tumors. Am J Roentgenol. 2003; 181: 695-700. PubMed:
  4. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: Complications encountered in a multicenter study. Radiology. 2003; 226: 441-451. PubMed:
  5. Brunello F, Cantamessa A, Gaia S, Carucci P, Rolle E, et al. Radiofrequency ablation: technical and clinical long-term outcomes for single hepatocellular carcinoma up to 30 mm. Eur J Gastroenterol Hepatol. 2013; 25: 842-849. PubMed:
  6. N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrié N, Grando V, et al. Radiofrequency ablation of hepatocellular carcinoma: Long-term results and prognostic factors in 235 western patients with cirrhosis. Hepatology. 2009; 50: 1475-1483. PubMed:
  7. Takaki H, Yamakado K, Nakatsuka A, Yamada T, Shiraki K, et al. Frequency of and risk factors for complications after liver radiofrequency ablation under ct fluoroscopic guidance in 1500 sessions: Single-center experience. Am J Roentgenol. 2013; 200: 658-664. PubMed:
  8. Tamano M, Hashimoto T, Kojima K, Maeda C, Hiraishi H. Diagnosis of hepatic hydrothorax using contrast-enhanced ultrasonography with intraperitoneal injection of Sonazoid. J Gastroenterol Hepatol. 2010; 25: 383-386. PubMed:
  9. Kim JS, Kim HS, Myung DS, Lee GH, Park KJ, et al. A case of diaphragmatic hernia induced by radiofrequency ablation for hepatocellular carcinoma. Korean J Gastroenterol. 2013; 62: 174-178. PubMed:
  10. Lin MW, Lee JM. Video-assisted Thoracoscopic Surgery for Diaphragmatic Defect Complication With Refractory Hydrothorax Related to Radiofrequency Ablation. J Formos Med Assoc. 2010; 109: 673-675. PubMed: