title: Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma.
abstract: Transarterial chemoembolization (TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma (HCC). Post-TACE pulmonary complications resulting in acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous (AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolizationviathe right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.
authors.affiliation: Department of Medicine, Scripps Clinic - Scripps Green Hospital, La Jolla, CA 92037, United States.
authors.forename: Quan M
authors.initials: QM
authors.lastname: Nhu
authors.affiliation: Division of Interventional Radiology, Scripps Clinic - Scripps Green Hospital, La Jolla, CA 92037, United States.
authors.forename: Harry
authors.initials: H
authors.lastname: Knowles
authors.affiliation: Scripps Translational Science Institute, La Jolla, CA 92037, United States.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Pockros
authors.affiliation: Scripps Center for Organ Transplantation, Scripps Clinic - Scripps Green Hospital, La Jolla, CA 92037, United States.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Frenette
keywords: Acute lung injury; Acute respiratory distress syndrome; Hepatocellular carcinoma; Liver cirrhosis; Pneumonitis; Pulmonary complications; Pulmonary oil embolism; Transcatheter arterial chemoembolization