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Chest clinic
Images in Thorax
Bilious pleuritis following transpulmonary radiofrequency ablation of liver metastases
  1. Asli Kalin1,
  2. Maged Hassan2,
  3. Mark Anderson3,
  4. Najib Rahman2
  1. 1 Department of Respiratory Medicine, John Radcliffe Hospital, Oxford, UK
  2. 2 Oxford Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, University of Oxford, Churchill Hospital, Oxford, UK
  3. 3 Department of Radiology, University of Oxford, Churchill Hospital, Oxford, UK
  1. Correspondence to Dr Maged Hassan, Oxford Centre for Respiratory Medicine, Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Roosevelt Drive, Oxford OX3 7LE, UK; maged.fayed{at}ouh.nhs.uk, magedhmf{at}gmail.com

https://doi.org/10.1136/thoraxjnl-2017-210508

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    A 55-year-old man with pancreatic cancer metastatic to the liver underwent percutaneous radiofrequency ablation (RFA) of the liver deposits. The liver harboured four metastatic foci, the largest of which was located at the posterior part of the right lobe just below the diaphragm (figure 1A). Due to the difficult anatomic location, transpulmonary approach was chosen for RFA and CT guidance was needed rather than ultrasound.

    Figure 1

    (A) The main metastatic deposit at the posterior portion of the right liver lobe. (B,C) Bile-stained pleural fluid drained.

    Under CT guidance an Accu 2i probe (Acculis Microwave Tissue Ablation System, AngioDynamics, Latham, New York, USA) was advanced into the four liver metastases. Ablation was performed at 140W at multiple sites for a total of 50 min. Small subcapsular haematoma …

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    Footnotes

    • Contributors AK and NR were the treating doctors. MA performed the radiological intervention. AK collected the images and clinical history. MH contributed to writing the case report and discussion.

    • Funding MH is a recipient of a European Respiratory Society Long-term research fellowship – ERS LTRF 2016 - 7333.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.