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Fatal bile pulmonary embolism after radiofrequency treatment of a hepatocellular carcinoma

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Abstract

Radiofrequency is increasingly used to manage liver tumors. This report describes the case of a 74-year-old man who received two courses of percutaneous radiofrequency thermal ablation for a hepatocellular carcinoma over a 4-month period. He subsequently required computed tomography-guided drainage for an area of intrahepatic necrosis. During the procedure, hemobilia developed, followed by respiratory distress and collapse. The diagnosis of bile pulmonary embolism was established on the basis of high biliary acid concentrations in pulmonary fluid aspiration and blood plasma. Radiofrequency thermoablation provides local control of advanced liver tumors with low recurrence and morbidity. However, this interventional procedure risks damage to liver parenchyma involving vascular and biliary structures, which may lead to biliary–venous fistula and possible bile emboli.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires, 1 Place de l’Hôpital, 67091 Strasbourg Cedex, France

    C. Schmidt-Mutter, T. Breining, E. Canela & J. -P. Dupeyron

  2. Department of Radiology B, Hôpital Civil, Hôpitaux Universitaires, 1 Place de l’Hôpital, 67091 Strasbourg Cedex, France

    A. Gangi

  3. Department of Digestive and Endocrine Surgery, Hôpital Civil, Hôpitaux Universitaires, 1 Place de l’Hôpital, 67091 Strasbourg Cedex, France

    I. Jourdan & D. Mutter

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  1. C. Schmidt-Mutter
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  2. T. Breining
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  3. A. Gangi
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  4. E. Canela
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  5. I. Jourdan
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  7. J. -P. Dupeyron
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Correspondence to C. Schmidt-Mutter.

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Schmidt-Mutter, C., Breining, T., Gangi, A. et al. Fatal bile pulmonary embolism after radiofrequency treatment of a hepatocellular carcinoma . Surg Endosc 17, 2028–2031 (2003). https://doi.org/10.1007/s00464-003-4239-4

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  • DOI: https://doi.org/10.1007/s00464-003-4239-4

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