title: A case of hepatocellular carcinoma with skin injury of the upper abdominal wall after transcatheter arterial chemoembolization: a case report.
abstract: BACKGROUND
  Transcatheter arterial chemoembolization has been widely used to treat advanced hepatocellular carcinoma that cannot be treated by local ablation therapies or surgical resection. The effectiveness of transcatheter arterial chemoembolization in prolonging survival has been well established, and approximately one third of newly discovered hepatocellular carcinoma patients were repeatedly treated by transcatheter arterial chemoembolization in Japan. Various kinds of complications have been reported, and many of which are general complications such as hepatic coma, jaundice, fever-up, ascites, and bile duct injury. The hepatic falciform artery is found frequently during postmortem anatomic dissection and the incidence of hepatic falciform artery is reported to be over 60%. Hepatic falciform artery is known to be the responsible artery for supraumbilical skin rash development after arterial chemo infusion therapy; however, skin complications after transcatheter arterial chemoembolization are rare.
  
  
  METHODS
  A 70-year-old female with chronic hepatitis C infection was diagnosed as having hepatocellular carcinoma (S4, 20 mm in diameter). Transcatheter arterial chemoembolization was performed via the left hepatic artery, which was a feeding artery of the hepatocellular carcinoma. Two days after that, supraumbilical skin rash with local tenderness and redness appeared. Retrospective analysis revealed that occlusion of the hepatic falciform artery branching from the left hepatic artery with micromaterials caused the skin lesion.
  
  
  CONCLUSIONS
  We should keep in mind that anticancer drugs or embolic materials can flow into the HFA and may cause abdominal wall injury after transcatheter arterial chemoembolization.
authors.affiliation: Department of Internal Medicine, Hiroshima City Hospital 7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518 Japan. kanzaki@qc4.so-net.ne.jp
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.forename: Koji
authors.initials: K
authors.lastname: Miyahara
authors.forename: Naoko
authors.initials: N
authors.lastname: Kajikawa
authors.forename: Sayo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sakakihara
authors.forename: Shota
authors.initials: S
authors.lastname: Iwadow
authors.forename: Shuji
authors.initials: S
authors.lastname: Uematsu
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Okamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shiraga
authors.forename: Motowo
authors.initials: M
authors.lastname: Mizuno
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Araki