1989 Volume 30 Issue 4 Pages 484-491
A 76-year-old male was diagnosed as having hepatocellular carcinoma (HCC), and a subsegmentectomy of the posterior part of the right hepatic lobe was performed. One year after the operation, recurrence of HCC was recognized, prompting transcatheter arterial embolization (TAE) to be performed several times in response to each HCC recurrence. About 5 hours after the 4th TAE (the 2nd Lipiodol-TAE: Lip-TAE) [8mg of mitomycin C (MMC), 10mg of lipiodol ultra-fluid (Lipiodol) and several gelation sponge cubes cut into 1-to 2-mm pieces (sp-cubes) were injected into the patient via the common hepatic artery: 6mg of MMC, 20mg of adriamycin (ADM), 8mg of Lipiodol and several sp-cubes were injected via the right inferior phrenic artery], disturbance of consciousness was recognized and cerebral metastases and Lipiodol accumulation toward these metastases were suspected by brain CT scans conducted over the next day. About 10days after this 4th TAE (about 3 years and 4 months after the initial operation), the patient died of pulmonary failure. The autopsy revealed that the disturbance of consciousness resulted from a combination of bleeding at the cerebral metastases and multiple cerebral infarctions due to both cancer cells and micro-fatty emboli (Lipiodol emboil) of Lipiodol flowing into the greater circulatory system after TAE. Moreover, the direct cause of death was pulmonary failure owing to Lipiodol-related interstitial pneumonitis. The cause of Lipiodol flow into the greater circulatory system was understood to be a consequence of the inferior phrenic artery-pulmonary vein anastomosis present.
When Lip-TAE is performed via the inferior phrenic artery, it should thus be noted whether or not this anastomosis exists, and if so, indication of Lip-TAE should then be decieded carefully. Furthermore, only a small amount of Lipiodol should be infused via the common hepatic artery.
