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 

作者机构：Department of RadiologyNagasaki University HospitalNagasaki 852-8501Japan Department of RadiologyNagasaki Harbor Medical CancerNagasaki 850-8555Japan Department of GastroenterologyNagasaki Harbor Medical CancerNagasaki 850-8555Japan Department of Radiological SciencesNagasaki University Graduate School of Biomedical SciencesNagasaki 852-8501Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第37期

页      面：4291-4296页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Transcatheter arterial chemoembolization Arteriovenous shunt Hepatocellular carcinoma Vascular lake Cerebral embolism 

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.