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.