J Korean Soc Radiol.  2015 Jan;72(1):33-37. 10.3348/jksr.2015.72.1.33.

A Rare Case of Empyema Developed after Transarterial Chemoembolization for Hepatocellular Carcinoma

• Sur YK
• Won JH
• Wang HJ
• Kim J

• KMID: 1823932
• DOI: http://doi.org/10.3348/jksr.2015.72.1.33

Abstract

A 60-year-old male patient who previously underwent transarterial chemoembolization for recurrent hepatocellular carcinoma three months ago presented to the emergency department with pleural effusion and hemoptysis. On serial review of plain radiographs and chest CT, transdiaphragmatic migration of Lipiodol from the treated area of the liver into the ipsilateral pleural cavity was demonstrated. The patient consequently developed empyema in the right thorax. Therefore, percutaneous drainage was performed. Empyema and pleural effusion regressed after 10 days of medical treatment and drainage. After that, the patient was transferred back to the local clinic upon full symptomatic recovery. Herein, we describe a rare complication of transarterial chemoembolization for hepatocellular carcinoma manifesting as an empyema secondary to the migration of the ethiodized oil content from the liver into the ipsilateral pleural cavity.

MeSH Terms

Carcinoma, Hepatocellular*
Drainage
Emergency Service, Hospital
Empyema*
Ethiodized Oil
Hemoptysis
Humans
Liver
Male
Middle Aged
Pleural Cavity
Pleural Effusion
Thorax
Tomography, X-Ray Computed
Ethiodized Oil

Figure

• 

  Fig. 1 Imaging characteristics of HCC demonstrated on CT before TACE, and on angiography and cone-beam CT during TACE. A. Arterial phase of contrast-enhanced CT demonstrates a hyperattenuated mass (arrow) in the liver dome. B. Digital subtraction angiography of the hepatic artery performed during TACE reveals a hypervascular HCC (arrow) in the liver dome. C. Cone-beam CT acquired immediately after TACE demonstrates positive uptake of Lipiodol by the tumor (arrow) surrounded by oily portograms. Note.-HCC = hepatocellular carcinoma, TACE = transarterial chemoembolization

• 

  Fig. 2 Coronal images from sequential chest CT performed twelve (A), sixteen (B), and seventeen (C) weeks after TACE. Gradual migration of the Lipiodol content (arrows) from the liver into the pleural cavity is noted. The Lipiodol finally became enclosed within an empyema (C). Note.-TACE = transarterial chemoembolization

• 

  Fig. 3 Sequential plain radiographs of the chest demonstrating gradual resolution of pleural empyema following percutaneous drainage and antibiotic therapy.

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