CTICasesIatrogenic Diaphragmatic Rupture after Microwave Ablation
Imaging findings
A patient with hepatocellular carcinoma at the dome of the liver has a pre-ablation CT showing an intact diaphragm. Microwave ablation was performed with multiple needle passes traversing the diaphragm, with visible Lipiodol. A follow-up CT months later shows edematous fat at the treated site and a large gaping defect in the diaphragm adjacent to the ablation zone, with mesenteric and omental fat herniating into the right hemithorax.
Key takeaways
Microwave ablation of lesions at the dome of the diaphragm carries a substantial risk of diaphragmatic injury, with reported diaphragmatic tears in roughly 20 percent of dome ablations, so treating lesions in this location with microwave ablation is generally discouraged. Recognizing a new diaphragmatic defect with fat herniation adjacent to a treated dome lesion identifies this iatrogenic complication, which is often managed conservatively.
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