Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature

A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma (HCC). Even after the injection of 7 mL of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly develo...

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Published inWorld journal of gastroenterology : WJG Vol. 24; no. 37; pp. 4291 - 4296
Main Authors Ishimaru, Hideki, Morikawa, Minoru, Sakugawa, Takayuki, Sakamoto, Ichiro, Motoyoshi, Yasuhide, Ikebe, Yohei, Uetani, Masataka
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 07.10.2018
Subjects
Adult
Aged
Aged, 80 and over
Angiography
Brain - diagnostic imaging
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - therapy
Case Report
Chemoembolization, Therapeutic - adverse effects
Contrast Media - chemistry
Ethiodized Oil
Female
Gelatin
Humans
Intracranial Embolism - etiology
Liver Neoplasms - pathology
Liver Neoplasms - therapy
Male
Middle Aged
Pulmonary Embolism - etiology
Tomography, X-Ray Computed
Cerebral embolism
Hepatocellular carcinoma
Vascular lake
Arteriovenous shunt
Transcatheter arterial chemoembolization
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Summary:A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma (HCC). Even after the injection of 7 mL of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.
Bibliography:ObjectType-Case Study-3
SourceType-Scholarly Journals-1
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ObjectType-Review-1
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Correspondence to: Minoru Morikawa, MD, Assistant Professor, Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. m-minoru@nagasaki-u.ac.jp
Author contributions: Ishimaru H, Morikawa M, and Sakamoto I designed the report; Sakugawa T and Motoyoshi Y collected the patient’s clinical data; Ishimaru H, Ikebe Y, and Uetani M wrote the paper.
Telephone: +81-95-8197354 Fax: +81-95-8197357
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v24.i37.4291