Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm

Figure 1 One patient with a 7. 5-cm hemangioma mainly in segment 8 in the computed tomography-guided ablation group developed a diaphragmatic rupture after ablation. A: A 40-year-old woman in the computed tomography (CT)-guided radiofrequency (RF) ablation group had a 7.5-cm hemangioma in segment 8, as illustrated on an abdominal CT scan; B: During CT-guided ablation, the lesion became depressed and commenced outgassing; C: Four days after ablation, CT scan of the chest showed a multiloculated pleural effusion occupying the right hemithorax with collapse of the right lung; D: Drainage via a chest tube was unsuccessful. She subsequently underwent thoracotomy; E: Two chest tubes were inserted into the pleural space; F: At 6 mo after ablation, CT scans showed that the hemangioma was completely ablated and markedly smaller without development of a diaphragmatic hernia.

Figure 2 Complete ablation is achieved in a patient in the laparoscopic ablation group. A: A 45-year-old woman in the laparoscopic ablation group had an 8.0-cm hemangioma in segment 5, as seen on an abdominal computerized tomography (CT) scan; B: On laparoscopic views, the tumor is evident on the superior surface; C: The lesion became a depressed mass of hard texture after RF ablation; D: The hemangioma disappeared completely 1 mo after ablation, as illustrated on an abdominal CT scan.