Tuberc Respir Dis.  2015 Oct;78(4):469-472. 10.4046/trd.2015.78.4.469.

A Case of Cryptogenic Organizing Pneumonia after Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

• Kim AR
• Yoo KH
• Lee KY
• Kim SJ
• Kim HJ
• Kim JH
• Rhyu YA

• KMID: 2320730
• DOI: http://doi.org/10.4046/trd.2015.78.4.469

Abstract

Cryptogenic organizing pneumonia (COP) is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts, and alveolae. The etiology is usually unknown; however, there are several known causes and associated systemic diseases. Corticosteroid therapy is the best treatment option and the prognosis of COP is good, with recovery in up to 80% of patients. We described a patient with in-operable hepatocellular carcinoma (HCC) undergoing chemoembolization with doxorubicin in a drug-eluting bead (DEB). COP developed in the patient after chemoembolization but resolved spontaneously in several months.

Keyword

Cryptogenic Organizing Pneumonia; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic

MeSH Terms

Bronchioles
Carcinoma, Hepatocellular*
Chemoembolization, Therapeutic
Cryptogenic Organizing Pneumonia*
Doxorubicin
Humans
Lung Diseases
Prognosis
Doxorubicin

Figure

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  Figure 1 (A) Initial computed tomography (CT) scan upon diagnosis in November 2013. (B) Follow-up CT scan after two courses of transcatheter arterial embolization (TACE) with symptom of dyspnea. (C) Follow-up CT scan 4 months after discharge. No active lung lesion was observed before TACE as indicated (A). After TACE, multifocal patchy consolidation, ground glass appearance, and fibrotic bands appeared on both peripheral lung fields as indicated (B). (C) An improvement in the lung lesions over time.

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  Figure 2 Patchy distribution of organizing pneumonia with preserved lung architecture was observed (H&E stain, ×400).

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  Figure 3 CT scan taken on the day after angiography indicated GGO patch lesion in the right lower lung, from dye smeared in through the shunt.

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  Figure 4 Angiography approached from the proximal portion of the right hepatic artery indicated a shunt in the pulmonary circulation system. A catheter for chemoembolization was placed distally from the shunt for doxorubicin infusion.

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