간세포암종 환자에서 경동맥화학색전술 후 발생한 뇌 혈관 색전증

• Published in: The Korean journal of gastroenterology Vol. 54; no. 2; pp. 130 - 134
• Main Authors: 정필진, Pil Jin Chung, 박선영, Seon Young Park, 김영일, Young Il Kim, 윤경원, Kyoung Won Yoon, 조성범, Sung Bum Cho, 최성규, Sung Kyu Choi, 류종선, Jong Sun Rew
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.08.2009
• Subjects: Carcinoma; Cerebral embolism; Hepatocellular; Iodized oil
• ISSN: 1598-9992

Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Although various complications of TACE have been reported, cerebral lipiodol embolism after TACE is rare. We report a 67-year-old man, who had patent foramen ovale and developed cerebral lipiodol embolism after TACE via the inferior phrenic artery. At 20 months after third TACE of 3 cm sized HCC in the left hepatic lobe, computed tomography (CT) revealed about 1.6 cm newly developed HCC in the anterior superior segment of right hepatic lobe. The angiogram revealed the HCC was supplied from the right inferior phrenic artery. Toward the end of TACE, there were accumulations of the iodized oil in the pulmonary vasculature. Immediately after TACE, he complained of weakness in right upper and lower limbs and sensory decrease in right limbs and right hemitrunk. Magnetic resonance imaging revealed a cerebral lipiodol embolism. Transesophageal echocardiography revealed no visible thrombi but contrast-echocardiography using hand agitated saline revealed an intracardiac right to left shunt consistent with patent foramen ovale. Motor weakness and sensory decrease were gradually improved, and all neurological symptoms disappeared over 4 weeks. (Korean J Gastroenterol 2009;54:130-134)