Acute respiratory distress syndrome after transcatheter arterial chemoembolization of hepatocellular carcinomas.
BACKGROUND
Acute respiratory distress syndrome (ARDS) associated with pulmonary lipiodol embolism is a rare complication of transcatheter arterial chemoembolization (TACE). We performed a survey of ARDS associated with pulmonary lipiodol embolism after TACE.


METHODS
A retrospective analysis of the cases of all patients with hepatic tumors who received transcatheter arterial embolization or TACE between January 2006 and December 2006 was performed. The diagnosis of pulmonary lipiodol embolism was confirmed by chest computed tomography (CT).


RESULTS
The diagnosis of ARDS associated with pulmonary lipiodol embolism was confirmed in 4 patients. All had large (> or =5 cm) and hypervascular tumors. There was no evidence of hepatocellular carcinoma arteriovenous shunting in any of our patients as determined by angiography and multidetector CT. The volumes of lipiodol infused in the 4 patients were 50, 20, 30, and 20 mL. Only 2 patients received injections of carcinostatic agents. The onset of respiratory symptoms occurred between 1 hour and 4 days after TACE. Respiratory symptoms consisted of dyspnea and tachypnea. Chest CT scans revealed linear high-density shadows, suggestive of lipiodol retention in both lungs of all patients.


CONCLUSIONS
Pulmonary lipiodol embolism after TACE can occur within a short time frame. Whether or not there is intrahepatic arteriovenous shunting detected by multidetector CT and angiography, clinicians should avoid high doses of iodized oil and carcinostatic agents. We suggest that CT should be used for the diagnosis of pulmonary lipiodol embolism.
Wu
Geng-Chin
GC
Division of Pulmonary Medicine, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Lungtan, Taoyuan, Taiwan.
Perng
Wann-Cherng
WC
Chen
Chien-Wen
CW
Chian
Chih-Feng
CF
Peng
Chung-Kan
CK
Su
Wen-Lin
WL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002406:Catheterization, Peripheral; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D007459:Iodized Oil / Q000008:administration & dosage / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D007459:Iodized Oil; D004317:Doxorubicin