Acute intraprocedural cardiac tamponade during microwave ablation of hepatocellular carcinoma in segment 2: A case report of emergency percutaneous salvage.

Microwave ablation (MWA) is an established treatment for hepatocellular carcinoma (HCC), but its application in the left hepatic lobe (segment 2) carries a rare but life-threatening risk of thermal injury to the pericardium. We report a case of an 84-year-old male who developed acute cardiac tamponade during MWA of a 2.5 cm HCC. Despite maintaining a safe parenchymal margin and real-time ultrasound monitoring of the needle tip, the patient suffered sudden hemodynamic collapse. Immediate diagnosis via bedside ultrasound and emergency US-guided pericardiocentesis with an 8F catheter placement led to instant stabilization. Follow-up at one month confirmed complete resolution and successful tumor ablation.