Percutaneous CT-Guided Ablation in the Hepatic Dome: Artificially Induced Pneumothorax for Safe Transpleural Access

Abstract

Ablative therapies have become a great alternative to surgical treatment of hepatic nodules. Some technical difficulties may negatively influence the effectiveness of this therapy, such as lesions located near the diaphragm. The transthoracic approach is commonly used to access these lesions. However, it is associated with an increased risk of complications, such as pneumothorax, hemothorax, alveolar bleeding, and others. We report a case of a radiofrequency ablation of a lesion in the hepatic dome, where an artificially induced pneumothorax was performed to guarantee a safe and effective access. The air was easily injected by a spinal needle and later aspirated by a single-lumen catheter. Induced pneumothorax shoud be considered in ablation of hepatic dome lesions, mainly when the transhepatic access is not appropriate.