Nicolas Alberti

Rare complications after lung percutaneous radiofrequency ablation: Incidence, risk factors, prevention and management

Among image-guided thermo-ablative techniques, percutaneous radiofrequency ablation (PRFA) is the most widely used technique for the treatment of primary and secondary lung malignancies. Tolerance of PRFA in the lung is excellent. However, relatively little is known about potential rare complications. This article presents both the clinical and imaging features of lung PRFA complications as well as their prevention and management. Complications may be classified in four groups: pleuropulmonary (e.g., bronchopleural or bronchial fistula, delayed abscess or aspergilloma inside post-PRFA cavitations, pulmonary artery pseudo aneurysm, gas embolism and interstitial pneumonia); thoracic wall and vertebral (e.g., rib or vertebral fractures and intercostal artery injury); mediastinal and apical (e.g., neural damage); or diaphragmatic. Most complications can be managed with conservative treatment, percutaneous or endoscopic drainage, or surgical repair.

Pulmonary artery pseudoaneurysm after radiofrequency ablation: report of two cases.

Abstract We report two cases of pulmonary arterial pseudoaneurysms (PAs) following percutaneous radiofrequency ablation (PRFA). The first patient was a 74-year-old Caucasian man who was treated for a secondary location of an advanced melanoma. A computed tomography scan at 72 h after the procedure, performed for basithoracic pain, hyperthermia and haemoptysis, revealed a 17-mm PA within the ablative zone. A lobectomy was performed. The second patient was an 80-year-old white man followed up for a right apical lung adenocarcinoma. Massive haemoptysis occurred 24 h after PRFA; emergent contrast-enhanced CT and pulmonary arteriography revealed a pulmonary artery PA (20 mm diameter), which was embolised with coils. The initial clinical course was satisfactory; however, 15 days after the procedure, the patient unfortunately presented a new massive haemoptysis and died a few hours later. The long ablation duration and the multiple repositioning of the electrodes might have been risk factors for this rare and potentially lethal complication.

23 Lung Metastases Treated by Radiofrequency Ablation Over 10 Years in a Single Patient: Successful Oncological Outcome of a Metastatic Cancer Without Altered Respiratory Function

An 82-year-old man, who was diagnosed in 2002 with an oncocytic (Hürthle cell) thyroid carcinoma, was initially treated by local surgery and was refractory to radioiodine treatment. The patient had successive secondary recurrences from 2006 onwards. Metastases were suspected due to an elevation of thyroglobulin in serum. Hypermetabolic nodules were targeted using FDG PET as well as CT-guided radiofrequency ablations. Thyroglobulin levels decreased following each procedure. 10 years later, tolerance and efficacy are excellent; 23 lung metastases have been treated during 11 sessions without current relapse. Respiratory function and quality of life are not altered. This report illustrates how radiofrequency ablation can be efficiently integrated into the long-term management of poorly aggressive oligometastatic cancer, in combination with other local and/or systemic therapies.

Hepar lobatum carcinomatosum associated with liver metastases from breast cancer: Report of five cases

BACKGROUNDS AND AIMS Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure. METHODS Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL). RESULTS All the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found. CONCLUSION Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.

From a typical focal nodular hyperplasia to a fibrotic band with capsular retraction: A case report

Figure 1. Line A. First MR examination (2006), showing two hyper vascular lesions (lesion 1 and 2), developed in a non-dysmorphic, non-fatty liver and localized in segment IV, slightly hyperintense on T2-weighted sequence, with intense enhancement at the arterial phase without wash-out. All these findings were consistent with typical FNHs. Line B. Second MR examination (2009), showing a reduction size of Observation

Intravertebral pseudomeningocele: an unusual complication after disc surgery.

BACKGROUND CONTEXT Pseudomeningoceles are most commonly the result of dural tear during spine surgery. They may sometimes slowly enlarge but they generally develop inside the spinal canal, toward the foramina or toward the surgical incision. PURPOSE To describe a late and exceptional complication of a surgical discectomy. STUDY DESIGN A case report. METHODS We report a unique case of a large asymptomatic pseudomeningocele strictly developed in the L5 vertebra, discovered incidentally in a 38-year-old woman. Computed tomography and magnetic resonance imaging showed a large cystic lesion involving the vertebral body and the left pedicle of L5 without contrast enhancement. There was neither extension of the cyst toward the vertebral lamina nor toward the spinal canal. Consent to publish the data was obtained from our patient. RESULTS Diagnosis was performed during transpedicular image-guided puncture, when opacification of the cyst revealed dural communication. Biochemical analysis and cytology confirmed the presence of cerebrospinal fluid and absence of tumoral cells. CONCLUSIONS Dural tear was considered as a neglected complication after surgical discectomy at the same level performed 18 years ago. Differential diagnoses of cystic spinal lesions are discussed.

B type-Bing-Neel syndrome with MRI follow-up: a case report and review of its presentations.

Journal of Neuroradiology - In Press.Proof corrected by the author Available online since mardi 1 juillet 2014

Ectopic pancreatic tissue in the jejunal mesentery.

A 65-year-old man attended our centre for the first time for the follow-up of a Lieberkuh-nian adenocarcinoma of the right colon, which had been in remission since surgicalintervention four years previously. The patient, who had no other remarkable medicalhistory, was clinically asymptomatic and laboratory tests showed no abnormalities. Morespecifically, there was no increase in serum CEA and CA19.9 levels which had been raisedprior to surgery.As part of the follow-up of colon cancer, computed tomography (CT) examination(Figs. 1—3) and a positron emission tomography scan with fluorodeoxyglucose (

Incidental abdominal mass during the follow-up of colon cancer after treatment

A 65-year-old man attended our centre for the first time for the follow-up of a Lieberkühnian adenocarcinoma of the right colon, which had been in remission since surgical intervention four years previously. The patient, who had no other remarkable medical history, was clinically asymptomatic and laboratory tests showed no abnormalities. More specifically, there was no increase in serum CEA and CA19.9 levels which had been raised prior to surgery. As part of the follow-up of colon cancer, computed tomography (CT) examination (Figs. 1—3) and a positron emission tomography scan with fluorodeoxyglucose (18F-FDG PET-CT) (Fig. 4) were performed.