crinological studies were performed. Laboratory studies revealed abnormally high levels of serum cortisol (58.6 µg·dl Ϫ1 ), urinary 17-OHCS (18 mg·day Ϫ1 ), and urinary cortisol (1860 µg·day Ϫ1 ) and a low level of ACTH (5.5 pg·ml Ϫ1 ). Furthermore, MRI revealed a left adrenal tumor 3 cm in diameter. Cushing's syndrome was diagnosed from these data at 28 weeks of gestation. Arterial hypoxia was not observed (PaO 2 ϭ 96 mmHg, FiO 2 ϭ 0.21). Because the hypertension could not be controlled by medications (α-methyldopa and furosemide), she was scheduled for laparoscopic adrenalectomy at 31 weeks of gestation. She was premedicated with diazepam (5 mg, p.o.) and famotidine (20 mg, p.o.) 4 h before anesthesia. In the operating room, an epidural catheter was placed 5 cm cephalad via the T9-10 interspace with a Tuohy needle (17 G) using the saline loss of resistance technique in the lateral position. As a test dose, 3 ml of 2% mepivacaine was injected through the epidural catheter, and no hypesthesia was observed after 10 min of injection. An additional 10 ml of 2% mepivacaine was injected, and the hypesthesia level was obtained from T4 to T11 after 10 min of injection. Before induction, the blood pressure was 180/100 mmHg. Anesthesia was induced with 175 mg thiamylal and 0.1 mg fentanyl with cricoid pressure. The patient was intubated easily with 6 mg vecuronium. After intubation, the blood pressure was 168/92 mmHg, and no secretion could be aspirated through the endotracheal tube. Anesthesia was maintained with sevoflurane (1%-3%) and epidural infusion of 2% mepivacaine (5 ml·h Ϫ1 ). She was placed in the flexed lateral position and underwent laparoscopic adrenalectomy. The intraperitoneal pressure during laparoscopy was less than 10 mmHg. The blood pressure was almost stable (130-170/80-100 mmHg) before isolation of the adrenal gland and changed dynamically (85-190/55-100 mmHg) during isolation of the tumor. The total operating time was two and a half hours. Pathohistological study revealed that the adrenal tumor was an adenoma. During emer-

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We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.

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