Pulmonary infarct after transarterial chemoembolization

摘要

Extrahepatic collateral vessels commonly develop to supply hepatocellular carcinoma (HCC), and their presence can decrease procedure efficacy and increase risks of chemoembolization (1). We describe a patient with HCC and multiple prior transarterial chemoembolization procedures who presented with a basilar pulmonary infarction after transarterial chemoembolization performed for embolization of a dominant superior epigastric arterial tumor supply. Although pulmonary infarction in itself is a rare complication, direct communication between collateral arterial tumor supply and the pulmonary artery is remarkable.A 76-year-old man with a history of HCC, hypertension, and end-stage renal disease presented for repeat transarterial chemoembolization of a large residual enhancing lesion in the superior aspect of the liver (Fig a). The patient had previously undergone multiple successful transarterial chemoembolization procedures with no complications. Selective arteriography demonstrated enlargement of the internal mammary artery and the superior epigastric artery (SGA) as was avoided, and the patient was successfully managed with image-guided percutaneous biliary decompression and pericardiocentesis.