CTICasesHepatopleural Fistula after Microwave Ablation of Hepatocellular Carcinoma
Imaging findings
Baseline CT in a 35-year-old with hepatocellular carcinoma shows cirrhosis and portal venous hypertension, with an ablation track running from the treated lesion up to the chest wall and a small pleural effusion on the concurrent chest CT. Four days later, CT angiography for chest pain shows a large effusion with a hydropneumothorax, an air-fluid level, and trapped lung. Delayed-phase imaging through the abdomen tracks the ablated necrotic area communicating across the diaphragm into the pleural space, confirmed on coronal reconstruction as a channel running up from the liver into the pleural cavity.
Key takeaways
A new hydropneumothorax days after hepatic ablation raises several possibilities — lung puncture during the procedure, or a biliothorax — and the distinguishing evidence came from a later phase of imaging rather than from the arterial study. Delayed-phase abdominal images demonstrated the ablation cavity communicating across the diaphragm, establishing a hepatopleural fistula. The case illustrates the value of reviewing all available phases rather than the single phase ordered for the presenting question.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Thymic Carcinoma Invading the Sternum and Anterior Chest WallNeoplastic
- Left Atrial Appendage AneurysmCongenital
- Pulmonary Mucormycosis (Cunninghamella) in a Stem Cell Transplant RecipientInfection
- Bacillus cereus Pneumonia in a Stem Cell Transplant RecipientInfection
- Renal Osteodystrophy with Reversible Cardiomegaly and Distal Clavicular ErosionMetabolic
- Renal Osteodystrophy with Brown Tumors and Pathologic Rib FractureMetabolic
- Pulmonary Tuberculosis with Bronchial Obstruction in a 5-Year-OldInfection
- Sarcoidosis with the Fairy Ring SignAutoimmune
See all cases from August 27, 2026 →