J Liver Cancer.  2020 Mar;20(1):60-66. 10.17998/jlc.20.1.60.

Lipiodol Pneumonitis Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

• Kim S
• Kim HY
• Lee SL
• Ku YM
• Won YD
• Kim CW

• KMID: 2505843
• DOI: http://doi.org/10.17998/jlc.20.1.60

Abstract

Transcatheter arterial chemoembolization (TACE) is a useful palliative therapeutic modality for hepatocellular carcinoma (HCC). Postembolization syndromes, such as fever, abdominal pain, and elevated liver enzyme levels are commonly known complications of TACE. One post-TACE pulmonary complication, lipiodol pneumonitis, is rarely reported. Lipiodol pneumonitis after TACE appears to be associated with chemical injury due to accidental perfusion of lipiodol to the lung vasculature, promoted by arteriovenous shunts within the hypervascular HCC. Here, we report a 42-year-old man with unresectable HCC and hepatic vein thrombosis. The patient was initially treated with TACE. The following day after TACE, acute respiratory symptoms such as dyspnea and cough developed with decreased oxygen saturation. Chest X-ray and computed tomography showed multiple patches and diffuse ground-glass opacities in both lung fields, suggesting of lipiodol pneumonitis. The patient’s condition and radiologic abnormalities subsequently improved after 2 weeks of conservative treatment alone.

Keyword

Lipiodol; Pneumonitis; Chemoembolization, Therapeutic; Hepatocellular carcinoma

Figure

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  Figure 1. Magnetic resonance imaging (MRI) findings. MRI showed a well-defined, round lesion with low signal intensity on unenhanced T1-weighted imaging (A). This lesion showed enhancement in the arterial (B) phase and washout on portal (C) and hepatobiliary (D) phases.

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  Figure 2. Angiography and computed tomography findings. The angiogram shows the findings of hepatocellular carcinoma supplied from the right hepatic artery and its segment 4 branch. It also shows arteriovenous shunting between the hepatic artery and hepatic vein. Infusion of an adriamycin and lipiodol mixture and subsequent embolization were performed (A). Abdominal computed tomography after transcatheter arterial chemoembolization showing a lipiodol-laden mass lesion in the right hemiliver (B).

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  Figure 3. Chest computed tomography (CT) findings. On the first day after transcatheter arterial chemoembolization, a non-enhanced chest CT shows consolidation with scattered lipiodol accumulation (arrows) in both lungs (A, B).

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  Figure 4. Follow-up chest X-ray findings. Multiple patches and diffuse ground-glass infiltrations were found in the bilateral lung on the first day (A) after transcatheter arterial chemoembolization (TACE). A follow-up chest X-ray showed progressive improvement of the infiltration of both lung fields on day 3 (B) and day 7 (C) after TACE. The last chest X-ray shows nearly complete resolution of lung infiltrations on day 14 (D). R-AP, right-anterior posterior.

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