[Cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma].
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.
Chung
Pil Jin
PJ
Miraero 21 Medical Center, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Park
Seon Young
SY
Kim
Young Il
YI
Yoon
Kyoung Won
KW
Cho
Sung Bum
SB
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D007459:Iodized Oil / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003287:Contrast Media; D007459:Iodized Oil