Acute respiratory distress syndrome after transcatheter arterial chemoembolization of hepatocellular carcinomas.

Background: Acute respiratory distress syndrome (ARDS) associated with pulmonary lipiodol embolism is a rare complication of transcatheter arterial chemoembolization (TACE). We performed a survey of ARDS associated with pulmonary lipiodol embolism after TACE.

Methods: A retrospective analysis of the cases of all patients with hepatic tumors who received transcatheter arterial embolization or TACE between January 2006 and December 2006 was performed. The diagnosis of pulmonary lipiodol embolism was confirmed by chest computed tomography (CT).

Results: The diagnosis of ARDS associated with pulmonary lipiodol embolism was confirmed in 4 patients. All had large (> or =5 cm) and hypervascular tumors. There was no evidence of hepatocellular carcinoma arteriovenous shunting in any of our patients as determined by angiography and multidetector CT. The volumes of lipiodol infused in the 4 patients were 50, 20, 30, and 20 mL. Only 2 patients received injections of carcinostatic agents. The onset of respiratory symptoms occurred between 1 hour and 4 days after TACE. Respiratory symptoms consisted of dyspnea and tachypnea. Chest CT scans revealed linear high-density shadows, suggestive of lipiodol retention in both lungs of all patients.

Conclusion: Pulmonary lipiodol embolism after TACE can occur within a short time frame. Whether or not there is intrahepatic arteriovenous shunting detected by multidetector CT and angiography, clinicians should avoid high doses of iodized oil and carcinostatic agents. We suggest that CT should be used for the diagnosis of pulmonary lipiodol embolism.