This case involves a middle-aged female patient who presented with abdominal pain and a hepatic lesion. She underwent a CT-guided liver biopsy and was discharged home. Later in the week, the patient began to complain of increased abdominal pain and was taken to the emergency room. A CT abdomen revealed a mass in her liver and she was transferred for a medical course of treatment. The morning after beginning her treatment, the patient was intubated her heart action began to slow. She suffered cardiac arrest. The patient was taken for interventional radiology drainage of the mass and the middle hepatic artery was embolized. The patient passed away a few hours later from liver failure. An expert in interventional radiology was sought to review the records and opine on whether a delay in hepatic artery embolism during the medical management of the liver mass was the likely cause of death.
Question(s) For Expert Witness
- 1. How often do you perform hepatic artery embolizations?
- 2. How often do you perform CT-guided liver biopsies?
- 3. What are the guidelines for performing hepatic artery embolization after failed medical management of a liver hematoma?
Expert Witness Response E-007945
I am a practicing interventional radiologist and have vast experience performing both liver biopsies and IR embolizations. I do many CT- and ultrasound-guided procedures/biopsies as an outpatient IR physician. I also work at hospitals on a consulting basis and in this capacity, I routinely perform liver embolizations for cancer and trauma patients. I have performed several hundred liver embolizations. I have reviewed cases like this one for internal review as I was in charge of quality/morbidity-mortality conferences for 10+ years. In this case, I would be able to speak to both the standard of care for performing outpatient IR liver biopsies as well as the possibility of a delay in care before IR embolization of an active hematoma. Several items would need further examination, especially the type of biopsy that was done and the location of the lesion. I am concerned about the fact that this patient died of liver failure that this may have been a very large bleed.