Korean J Gastroenterol.  2017 Oct;70(4):198-201. 10.4166/kjg.2017.70.4.198.

A Case of Hypertensive Crisis without a Surge in Adrenal Hormones after Radiofrequency Ablation as a Treatment for Primary Hepatocellular Carcinoma

• Lee KJ
• Ryu SH

• KMID: 2392916
• DOI: http://doi.org/10.4166/kjg.2017.70.4.198

Abstract

Radiofrequency ablation (RFA) is a minimally invasive procedure that has been considered as a relatively safe treatment for patients with small hepatocellular carcinoma (HCC). However, RFA has been shown to be associated with complications including mechanical and thermal damage. A 74-year-old man with hepatitis C virus-associated HCC was admitted to our hospital. Abdominal computed tomography revealed two lobulated-HCC in segments 4 and 5. He had no medical history of hypertension and cardiac disease. During RFA, blood pressure was elevated to 200/140 mmHg. There was no evidence of pulmonary embolism, aortic dissection, or ischemic heart disease. Laboratory findings for catecholamine surge were all within normal limits. After continuous intravenous nitroglycerin and oral beta-blocker treatment, patient's blood pressure gradually decreased and back within the normal range. Hypertensive crisis after RFA treatment for HCC is rare. Most reported cases of hypertensive crisis during RFA were related to adrenal gland injury with a release of catecholamine. In our case, the site of HCC was not close to the adrenal gland, and there was no evidence of catecholamine surge. Herein, we report a very rare case of hypertensive crisis without a surge in adrenal hormones after RFA treatment for HCC.

Keyword

Carcinoma, hepatocellular; Hypertension; Hypertensive crisis; Radiofrequency catheter ablation

MeSH Terms

Adrenal Glands
Aged
Blood Pressure
Carcinoma, Hepatocellular*
Catheter Ablation*
Heart Diseases
Hepatitis C
Humans
Hypertension
Myocardial Ischemia
Nitroglycerin
Pulmonary Embolism
Reference Values
Nitroglycerin

Figure

• 

  Fig. 1 Computed tomography image of 2.2-cm lobulated hepatocelluar carcinoma in S5 (white arrow). Early enhancement on arterial phase (A), wash out pattern on portal phase (B), wash out pattern on delayed phase (C).

• 

  Fig. 2 Graph demonstrates the episode of sever hypertension during the RFA procedure (16:40 - RFA started, 18:10 - continuous intravenous nitroglycerin started). SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; RFA, radiofrequency ablation; NTG, nitroglycerin.

• 

  Fig. 3 Computed tomography image after radiofrequency ablation for hepatocelluar carcinoma in S4 (A). Computed tomography image after second radiofrequency ablation for hepatocelluar carcinoma in S5 (B).

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