Thermal osteonecrosis of the rib after radiofrequency ablation in the thorax

A patient underwent radiofrequency (RF) ablation of a pleural-based pulmonary metastasis from treated hepatocellular carcinoma. Ten months after the procedure, computed tomography and positron emission tomography findings raised the concern of tumor recurrence with invasion of the chest wall, for which the patient underwent thoracotomy with resection. Pathologic evaluation demonstrated osteonecrosis of the rib but no malignancy. This case illustrates that thermal osteonecrosis may occur after RF ablation of a pleural-based lesion.