J Korean Soc Radiol.  2011 Dec;65(6):577-583. 10.3348/jksr.2011.65.6.577.

Pulmonary Lipiodol Accumulation after Transarterial Chemoembolization: CT Findings and Its Radiologic Outcomes

• Youn I
• Chong S
• Kwak BK
• Shim HJ
• Seo GY
• Seo JS
• Kim JK

• KMID: 2002925
• DOI: http://doi.org/10.3348/jksr.2011.65.6.577

Abstract

PURPOSE
To evaluate CT findings and radiologic outcomes of pulmonary lipiodol accumulation (PLA) after transarterial chemoembolization (TACE).
MATERIALS AND METHODS
This retrospective study involved 488 TACEs for hepatocellular carcinoma (HCC) (n = 160) and hepatic metastasis for non-hepatic malignancies (n = 7) in 167 patients. We reviewed the patient clinicoradiologic findings before and after TACE and calculated the incidence of PLA and PLA resolution time after initial CT and after TACE.
RESULTS
Lipiodol accumulation in the lungs was seen under CT after TACE in seven patients (M : F = 6 : 1, mean age 61 years). The incidence of PLA at CT was 4.1% (7/167 patients). In five patients, associated intrathoracic abnormalities including pleural effusion with (n = 3) or without consolidation (n = 2) were revealed at CT scans. The CT resolution time and PLA recovery time were 56 +/- 54 days and 66 +/- 52 days, respectively.
CONCLUSION
The recovery time for lipiodol accumulation was 66 days. It is believed that the clinical and radiologic outcome of PLA without respiratory failure is promising, and conservative treatment will suffice when lipiodol accumulation in the lungs is seen in CT images after TACE.

MeSH Terms

Carcinoma, Hepatocellular
Chemoembolization, Therapeutic
Ethiodized Oil
Humans
Incidence
Iodized Oil
Lung
Neoplasm Metastasis
Pleural Effusion
Respiratory Insufficiency
Retrospective Studies
Tomography, Spiral Computed
Ethiodized Oil
Iodized Oil

Figure

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  Fig. 1 A 76-year-old man who presented with hemoptysis after TACE for hepatocellular carcinoma via right inferior phrenic (pure lipiodol 1.0 mL and emulsion 11 mL) and right hepatic arteries (pure lipiodol 1.0 mL and emulsion 3.0 mL) (A). Immediate chest radiograph after TACE (B) shows segmental atelectasis in the right lower lung zone (arrow) as well as right pleural effusions and a lipiodol laden mass lesion (arrowheads) in the right upper abdomen. At 3 days after TACE, a non-enhanced initial chest CT scan (C) shows consolidation with lipiodol accumulation in the right lower lobe (arrow) and right pleural effusions (star). At 153 days after TACE, a non-enhanced follow-up liver CT scan (D) shows complete improvement of the lipiodol accumulation and partial improvement of consolidation in the right lower lobe (arrow), as well as right pleural effusion. Note.-TACE = transarterial chemoembolization

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  Fig. 2 A 42-year-old man who underwent TACE for hepatocellular carcinoma via both the hepatic and right inferior phrenic arteries (pure lipiodol 3.0 mL and emulsion 11 mL). At 5 days after TACE, initial non-enhanced chest CT scan (A) shows lobular consolidation with lipiodol accumulation in the posterior basal segment of right lower lobe (arrow) and a lipiodol laden mass lesion in the hepatic dome (star). At 28 days after TACE, a non-enhanced follow-up liver CT scan (B) shows complete improvement of the lobular consolidation with lipiodol accumulation in the posterior basal segment of right lower lobe and no interval change of the lipiodol laden mass lesion in the hepatic dome. Note.-TACE = transarterial chemoembolization

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