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+A 49-year-old woman was admitted to the Department of Radiology of the Second Affiliated Hospital of Zhejiang University in October 2004 with right upper quadrant pain and weight loss.
+She was a hepatitis B virus carrier.
+Her α-fetoprotein level was 1185.3 ng/mL.
+Ultrasonography and computed tomography (CT) revealed a 10-cm mass in the posterior segments of the right liver lobe.
+A 1.5-cm mass was also found in the left lateral segment.
+These clinical signs indicated that the patient had inoperable HCC and Child-Pugh class A cirrhosis.
+TACE was offered to the patient.
+Angiogram demonstrated no obvious hepatic arterio-venous shunt, but multiple smaller masses in both lobes of the liver.
+An emulsion of oxaliplatin, pirarubicin, hydroxycamptothecin and lipiodol were prepared, 35 mL and 3 mL of the mixture were administered intra-arterially to the right and left hepatic artery, respectively.
+The patient experienced right upper quadrant pain after TACE and had an uneventful recovery.
+One month later, a second TACE procedure was performed via the right hepatic artery and 40 mL of the mixture was administered.
+On the next day, she experienced sudden acute dyspnoea and the peripheral oxygen saturation decreased to 90%.
+The chest X-ray showed some increased reticular shadows in the left lung, especially in the lower zones, and a chest CT scan revealed multiple iodized oil-like high-density materials in parenchyma of the lung (Figure ​1).
+After 10 mg dexamethasone i.v. and other supportive therapies were administered, the respiratory symptom was attenuated.
+Two days later, the patient suffered from a serious headache and transient consciousness loss, accompanying nausea and vomiting followed by confusion, lower extremity weakness.
+Non-contrast enhanced CT scanning showed multiple disseminated hyper-intense lesions in the brain, consistent with deposition of iodized oil (Figure ​2).
+One week later, her respiratory and neurologic symptoms disappeared completely, and she was discharged.
+The patient also consequently completed the other three TACE procedures, during which no similar symptoms occurred.