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Case Reports
. 2016 Nov;39(11):1644-1648.
doi: 10.1007/s00270-016-1415-1. Epub 2016 Jul 7.

RF Ablation of Giant Hemangiomas Inducing Acute Renal Failure: A Report of Two Cases

Aukje A J M van Tilborg  1 , Helena F Dresselaars  2 , Hester J Scheffer  3 , Karin Nielsen  4 , Colin Sietses  5 , Petrousjka M van den Tol  4 , Martijn R Meijerink  3
Affiliations
Case Reports

RF Ablation of Giant Hemangiomas Inducing Acute Renal Failure: A Report of Two Cases

Aukje A J M van Tilborg et al. Cardiovasc Intervent Radiol. 2016 Nov.

Abstract

Objective: In patients that require treatment for hepatic giant cavernous hemangiomas (GCH), radiofrequency ablation (RFA) has been suggested to represent a safe and effective alternative to invasive surgery. In a recent report of bipolar RFA, using two expandable needle electrodes, was uneventfully performed in patients with large GCH (>10 cm). The objective of this report is to present two cases in which bipolar RFA of symptomatic GCH was complicated by acute kidney injury.

Materials and methods: In 2015 we treated two patients for very large symptomatic GCH (15.7 and 25.0 cm) with bipolar RFA during open laparotomy.

Results: In both patients the urine showed a red-brown discoloration directly after the ablation. They became anuric and presented with progressive dyspnea, tachypnea, and tachycardia, requiring hemodialysis for a period of 1 month in one case. Lab results revealed hemepigment-induced acute kidney. Both patients fully recovered and both showed a complete relief of symptoms at 3 months following the procedure.

Conclusion: RFA for large GCHs can cause hemepigment-induced acute kidney injury due to massive intravascular hemolysis. The presented cases suggest that caution is warranted and advocate an upper limit regarding the volume of GCHs that can be safely ablated.

Keywords: Acute kidney injury; Giant cavernous hemangioma; Hemolysis; Radiofrequency ablation.

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Conflict of interest statement

Compliance with Ethical Standard Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
A 52-year-old female (case 1) with two large mating symptomatic GCHs in segment VII and VIII (Couinaud) of the liver (diameter of 10 and 5.7 cm) before A and after B bipolar RFA, showing a clear volume reduction. (*Fluid filled space caused by retraction of the tumor.)
Fig. 2
Fig. 2
A 41-year-old female (case 2) with a colossal and enlarging GCH occupying all segments of the right liver lobe (maximum diameter 25.0 cm) before A and after B debulking bipolar RFA, showing a fair volume reduction. (*Fluid filled space caused by retraction of the tumor.)
See this image and copyright information in PMC

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