Thoracoscopic Treatment of Massive Hemorrhagic Complication Due to Diaphragm Injury after Radiofrequency Ablation of Hepatocellular Carcinoma

The clinical application of radiofrequency ablation (RFA) of hepatic tumor has gradually been accepted as an effective and safe method for the treatment of small hepatic malignant tumors. However, the potential complications were often overlooked. We report a case of hepatitis C related hepatocellular carcinoma (HCC), who developed a massive hemothorax after a RFA procedure for treatment of recurrent HCC. The cause of hemothorax was finally proved to be a RFA needle injury of a diaphragm vessel and successively treated by a minimally invasive thoracoscopic surgery. Hemothorax after RFA procedure was long been thought as intercostals arterial injury, however, our case demonstrated that diaphragm injury might be the cause of RFA related hemothorax rather than intercostal artery injury, at least in some cases