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Complications After Interventional Sonography of Focal Liver Lesions

A 22-Year Single-Center Experience

Interventional Ultrasound Service, D. Cotugno Hospital, Naples, Italy.

Address correspondence and reprint requests to Antonio Giorgio, MD, Viale Colli Aminei 491, 80131 Naples, Italy; e-mail: assanui{at}infinito.it.

Objective. To analyze the complications of diagnostic and therapeutic sonographically guided interventional procedures of focal liver lesions observed during a 22-year period in a single center. Methods. Complications of sonographically guided diagnostic and therapeutic procedures on focal liver lesions, observed during a 22-year period in a single center, were reviewed. From 1979 to 2001, 13,222 patients (age range, 7–89 years; mean, 59 years; 8688 male and 4534 female) with 13,777 focal liver lesions underwent 16,648 sonographically guided biopsies and 3035 therapeutic procedures: pyogenic and amebic abscess aspiration, ethanol injection of hydatid liver cysts, and percutaneous ablative treatments (ethanol injection in either multiple or one-shot sessions, radio frequency ablation, and interstitial laser photocoagulation) of primary and secondary liver tumors. Results. The overall mortality was 0.06%. No death or major complication occurred after diagnostic procedures and liver abscess drainage. In the therapeutic group mortality was 0.6%: 1 patient died of anaphylactic shock during treatment of a hydatid cyst; 7 patients died after liver tumor ablation with ethanol injection (6 after one-shot treatments and 1 after multisession treatments). Major complications after liver tumor ablative procedures included 10 cases of acute liver failure, 2 cases of acute tubular necrosis, 2 cases of self-limiting hemoperitoneum, 2 cases of paralytic ileum, 2 abscesses, and 1 case of cholangitis. One case of a biliary cyst fistula and 1 case of intracystic hemorrhage occurred after treatment of hydatid liver cysts. Conclusions. Sonographically guided diagnostic biopsy of focal liver lesions and liver abscess drainage are safe procedures. In contrast, liver tumor ablation procedures have a low but definite risk of mortality and major complications. Puncture of hydatid cysts must be performed only in institutions that can treat anaphylactic shock.

Key Words: complications • focal liver lesions • interventional ultrasound.

Abbreviations: CNB, cutting needle biopsy • D-PAI, double percutaneous aspiration and ethanol injection • FNB, fine-needle biopsy • HCC, hepatocellular carcinoma • ILP, interstitial laser photocoagulation • INR, international normalized ratio • IV, intravenously • PAIR, puncture, aspiration, injection, and reaspiration • PEI, percutaneous ethanol injection • RF, radio frequency

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