Korean J Gastroenterol.  2017 May;69(5):316-320. 10.4166/kjg.2017.69.5.316.

Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization

• Lee K
• Song JE
• Jeong HS
• Kim DY

• KMID: 2383391
• DOI: http://doi.org/10.4166/kjg.2017.69.5.316

Abstract

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Keyword

Chemoembolization, therapeutic; Bronchial fistula; Carcinoma, hepatocellular; Lung abscess

MeSH Terms

Aged
Bile Ducts
Bronchial Fistula
Carcinoma, Hepatocellular
Chemoembolization, Therapeutic
Cholangiopancreatography, Endoscopic Retrograde
Cough
Fistula*
Hepatectomy
Humans
Liver Abscess
Lung Abscess*
Lung*
Sputum

Figure

• 

  Fig. 1 Contrast-enhanced chest computed tomography at admission day. Hepatic abscess and lung abscess are shown in this image. The arrow indicates fistula between lung abscess and liver abscess.

• 

  Fig. 2 Cholangiography via hepatic abscess drainage catheter. The arrow indicates contrast dye leakage from hepatic abscess to bronchus.

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  Fig. 3 Endoscopic retrograde cholangiopancreatography (ERCP) image. Endoscopic retrograde bile drainage was inserted via ERCP to treat hepatobronchial fistula by decompressing biliary pressure.

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  Fig. 4 Microscopic findings of the resected specimen (H&E, ×200). Postoperative pathology shows acute inflammation (neutrophil dominant) and necrosis.

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  Fig. 5 Microscopic findings of the resected specimen (H&E, ×200). Postoperative pathology shows acute inflammation (neutrophil dominant) and some viable cancer cells (arrows).

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  Fig. 6 Liver-pelvic contrast dynamic computed tomography after repair operation. The arrow indicates repaired fistula at the diaphragm.

Reference

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