Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma:A case report and review of the literature  

作　　者：Hideki Ishimaru Minoru Morikawa Takayuki Sakugawa Ichiro Sakamoto Yasuhide Motoyoshi Yohei Ikebe Masataka Uetani 

机构地区：[1]Department of Radiology,Nagasaki University Hospital,Nagasaki 852-8501,Japan [2]Department of Radiology,Nagasaki Harbor Medical Cancer,Nagasaki 850-8555,Japan [3]Department of Gastroenterology,Nagasaki Harbor Medical Cancer,Nagasaki 850-8555,Japan [4]Department of Radiological Sciences,Nagasaki University Graduate School of Biomedical Sciences,Nagasaki 852-8501,Japan

出　　处：《World Journal of Gastroenterology》2018年第37期4291-4296,共6页世界胃肠病学杂志（英文版）

摘　　要：A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.

关 键 词：Transcatheter arterial CHEMOEMBOLIZATION Arteriovenous shunt Hepatocellular carcinoma VASCULAR LAKE CEREBRAL EMBOLISM 

分 类 号：R57[医药卫生—消化系统]