TRANSTHORACIC PERCUTANEOUS ETHANOL INJECTION INTO THE LIVER

RATIONALE AND OBJECTIVES. The feasibility of the new transthoracic app roach of percutaneous ethanol injection through the lower lung to the subphrenic region of the liver was evaluated in normal rats. METHODS. Fourteen normal rats received percutaneous ethanol injection. A 22-gau ge fine needle was inserted into the liver via the thoracic cage and t hrough the lower lung parenchyma under computed tomographic (CT) guida nce. After ethanol (0.1-0.2 mL) was injected, three follow-up CT scans were performed: immediately after, 1 day after, and 1 week after the initial injection. All animals were killed 1 week after injection to e valuate macroscopic changes of the diaphragm and pleura. RESULTS. No m ajor complications were observed. Minor complications were observed in six rats; these included one pneumothorax (7%) and five band-like and streaky shadows (presumably pulmonary hemorrhages) (35%) on the CT sc an obtained immediately after the procedure. However, all complication s had disappeared spontaneously in the follow-up CT scan obtained 1 da y after the procedure. At autopsy, no pleural changes were seen. CONCL USIONS. This study demonstrates that percutaneous ethanol injection th rough the lower lung parenchyma is achievable. Although this study was performed only in normal rats, the transthoracic approach can be a co mplementary method of ultrasound-guided percutaneous ethanol injection for tumors in the subphrenic region of the liver. Further study will be needed in abnormal livers and then in human subjects to verify the safety and efficacy of this procedure.