Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1344-1348
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1344
Pulmonary embolism after arterial chemoembolization for hepatocellular carcinoma: An autopsy case report
Keiichi Hatamaru, Shunjiro Azuma, Takuji Akamatsu, Takeshi Seta, Shunji Urai, Yoshito Uenoyama, Yukitaka Yamashita, Kazuo Ono
Keiichi Hatamaru, Shunjiro Azuma, Takuji Akamatsu, Takeshi Seta, Shunji Urai, Yoshito Uenoyama, Yukitaka Yamashita, Department of Gastroenterology and Hepatology, Japan Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan
Kazuo Ono, Department of Pathology, Japan Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan
Author contributions: Hatamaru K and Yamashita Y designed the report; Hatamaru K, Azuma S, Akamatsu T, Seta T, Urai S and Uenoyama Y were the attending doctors; Ono K performed the pathological examinations; and Hatamaru K wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keiichi Hatamaru, MD, Department of Gastroenterology and Hepatology, Japan Red Cross Society Wakayama Medical Center, 4-20 Komatsubaradori, Wakayama 640-8558, Japan. papepo51@gmail.com
Telephone: +81-73-4224171 Fax: +81-73-4261168
Received: June 11, 2014
Peer-review started: June 12, 2014
First decision: July 9, 2014
Revised: July 22, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: January 28, 2015
Processing time: 229 Days and 19.7 Hours
Abstract

We report an extremely rare case of pulmonary lipiodol embolism with acute respiratory distress syndrome (ARDS) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A 77-year-old man who was diagnosed with a huge HCC was admitted for TACE. Immediately after the procedure, this patient experienced severe dyspnea. We suspected that his symptoms were associated with a pulmonary lipiodol embolism after TACE, and we began intensive treatment. However, his condition did not improve, and he died on the following day. A subsequent autopsy revealed that the cause of death was ARDS due to pulmonary lipiodol embolism. No cases have been previously reported for which an autopsy was performed to explain the most probable mechanism of pulmonary lipiodol embolism; thus, ours is the first report for such a rare case.

Keywords: Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Pulmonary lipiodol embolism; Acute respiratory distress syndrome; Autopsy

Core tip: Transcatheter arterial chemoembolization (TACE) has become the first treatment choice for patients with non-surgical hepatocellular carcinoma (HCC). Common complications associated with TACE have been reported, which include acute hepatic failure, liver abscess, intrahepatic biloma, hepatic infarction, hepatic artery occlusion, gallbladder infarction, acute renal failure, and/or gastrointestinal mucosal ulceration. However, fatal complications are rare. Although a few cases with pulmonary lipiodol embolism were previously reported, to our knowledge there have been no pathological autopsy reports. Here we present a pathological autopsy report for a patient with a huge HCC who died due to pulmonary lipiodol embolism after TACE.