title: Resolution of hepatic encephalopathy following hepatic artery embolization in a patient with well-differentiated neuroendocrine tumor metastatic to the liver.
abstract: Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. erinjerj@mskcc.org
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.forename: Ajita
authors.initials: A
authors.lastname: Deodhar
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Thornton
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: George I
authors.initials: GI
authors.lastname: Getrajdman
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.forename: Diane L
authors.initials: DL
authors.lastname: Reidy
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use; D000792:Angiography; D003287:Contrast Media; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000379:methods*; D005780:Gelatin / Q000627:therapeutic use; D006499:Hepatic Artery; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000180:Acrylic Resins; D003287:Contrast Media; C496735:trisacryl gelatin microspheres; D005780:Gelatin