Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia.
We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.
Yamaura
K
K
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Higashi
M
M
Akiyoshi
K
K
Itonaga
Y
Y
Inoue
H
H
Takahashi
S
S
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002406:Catheterization, Peripheral; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D002648:Child; D003287:Contrast Media / Q000009:adverse effects*; D003422:Critical Care; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005471:Fluoroscopy; D005500:Follow-Up Studies; D018197:Hepatoblastoma / Q000098:blood supply / Q000628:therapy*; D006801:Humans; D007459:Iodized Oil / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy*; D008297:Male; D010100:Oxygen / Q000097:blood; D010108:Oxyhemoglobins / Q000032:analysis; D011175:Positive-Pressure Respiration; D011655:Pulmonary Embolism / Q000209:etiology*; D015641:Radiography, Interventional
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D003287:Contrast Media; D010108:Oxyhemoglobins; D007459:Iodized Oil; D004317:Doxorubicin; C027260:pirarubicin; D010100:Oxygen