Table 7:

Case Reports of Complications Following MRgHIFU Treatment for Uterine Fibroids

Author, Year, Country	Adverse Event	Case Detail
Kim KA et al, 2011 (100) Korea	Spontaneous vaginal expulsion of uterine fibroid	38-year-old woman with severe menorrhagia and resultant anemia underwent HIFU with an NPV ratio of 80%, and 2 weeks post underwent hysteroscopic resection for an incompletely discharged fibroid mass without adverse events.
Fukunishi H et al, 2007 (99) Japan	Unsuspected uterine leiomyosarcoma treated	40-year-old woman with menorrhagia and a 9-cm mass on the anterior uterine wall underwent HIFU with an NPV of 25%, after which symptoms resolved for a time but returned within 6 months. The tumour was morcellated by laparoscopic myomectomy, and leiomyosarcoma coexistent with degenerated fibroid was confirmed at histology. Subsequently the patient underwent definitive surgery (Wertheim operation with lymphadenectomy) without adjuvant chemotherapy and remained in good health 16 months following HIFU.
Leon-Villapolis J et al, 2005 (101) United Kingdom	Full thickness abdominal skin burn	39-year-old woman underwent HIFU and 2 weeks post developed a small area of hyperintensity close to the abdominal skin burn sites within the left rectus muscle initially treated with Flamazine dressing. No MR abnormalities were reported for the subcutaneous fat or muscle fascia. After the patient was referred to a burn centre, a full-thickness skin burn down to the abdominal fascia causing localized areas of subcutaneous fat necrosis was identified. The patient was hospitalized for a day and underwent surgery in which the burn areas were treated by excision as an ellipse and direct closure.

Abbreviations: HIFU, high-intensity focused ultrasound; MRgHIFU, magnetic resonance–guided high-intensity focused ultrasound; NPV, non-perfusion volume