Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia

Abstract

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.

Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children

“…Experience with HACE in children is, however, somewhat limited 12–17. The main problem is that chemoembolization is an invasive and technically demanding procedure requiring general anesthesia, and is associated with potential complications 18,19. In this study all four evaluable patients showed response to HACE.…”

Permanent and Peripheral Embolization: Temperature‐Sensitive p(N‐Isopropylacrylamide‐co‐butyl Methylacrylate) Nanogel as a Novel Blood‐Vessel‐Embolic Material in the Interventional Therapy of Liver Tumors

“…It is known that a relatively high‐viscosity emulsion is formed by a mixture of Lipiodol and blood, and that the emulsion is retained in the peripheral blood vessels. However, the Lipiodol emulsion is eliminated rapidly due to blood scouring and tissue clearance 35. The elimination results in vascular recanalization, which is one of the key reasons for the poor effect of Lipiodol on permanent embolization of liver tumors ().…”

Complications of Hepatic Chemoembolization

“…Embolization of lipiodol to the lungs may occur through arteriovenous shunting or portovenous shunting. 11 This shunting may not be detectable during TACE. Mild cases of lipiodol embolization may be asymptomatic and discovered incidentally by computed tomography (CT) with high-attenuation areas of lung.…”