Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days l ater, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobi lia) and a focal lesion with mixed echotexture in segment III (hepatic hema toma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that rad io-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular stru ctures.