Dellano D. Fernandes, MD, FRCPC, Paul B. Shyn, MD, Stuart G

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Gallbladder Needle Decompression During Radiofrequency Ablation of an Adjacent Liver Tumour Dellano D. Fernandes, MD, FRCPC, Paul B. Shyn, MD, Stuart G. Silverman, MD, FACR Canadian Association of Radiologists Journal Volume 63, Issue 3, Pages S37-S40 (August 2012) DOI: 10.1016/j.carj.2011.05.003 Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 1 (A) Ultrasound image, showing percutaneous needle decompression of the previously distended gallbladder through a transhepatic approach (arrow); a large volume of ascites surrounds the gallbladder (open arrow). (B) Ultrasound image obtained more inferiorly during radiofrequency ablation, showing the decompressed gallbladder (arrow), now retracted from the liver surface with intervening ascites noted (arrowhead); the radiofrequency electrodes enter segment 5 of the liver (open arrow); echogenic foci (double arrow) demarcate the developing subcapsular hepatic ablation zone. (C) Axial contrast-enhanced T1-weighted magnetic resonance image obtained 1 day after ablation, showing expected mild hyperintensity of the ablated tumour (arrow); there was no residual tumour enhancement, and the ablation zone margin around the tumour was satisfactory; the ablation zone extends to the liver capsule adjacent to the peritonealized surface of the gallbladder, with no gallbladder injury evident. Canadian Association of Radiologists Journal 2012 63, S37-S40DOI: (10.1016/j.carj.2011.05.003) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions

Figure 2 (A) Axial contrast-enhanced T1-weighted magnetic resonance image, demonstrating a hyperenhancing hepatocellular carcinoma in close proximity to a moderately distended gallbladder (arrow). (B) Axial unenhanced computed tomography (CT) image obtained immediately before ablation, demonstrating a distended gallbladder closely apposed to the liver capsule overlying the anticipated ablation zone. (C) Axial unenhanced CT image obtained immediately after radiofrequency ablation, showing a region of hypodensity with gas bubbles (arrow) in the hepatic ablation zone extending to the liver capsule; the decompressed gallbladder (arrowhead) is retracted from the ablation zone. Canadian Association of Radiologists Journal 2012 63, S37-S40DOI: (10.1016/j.carj.2011.05.003) Copyright © 2012 Canadian Association of Radiologists Terms and Conditions