Journal of Liver Cancer

Case Report

Lipiodol Pneumonitis Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Sungkeun Kim, Hee Yeon Kim, Su Lim Lee, Young Mi Ku, Yoo Dong Won, Chang Wook Kim; J Liver Cancer. 2020;20(1):60-66. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.60

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Transcatheter arterial chemoembolization (TACE) is a useful palliative therapeutic modality for hepatocellular carcinoma (HCC). Postembolization syndromes, such as fever, abdominal pain, and elevated liver enzyme levels are commonly known complications of TACE. One post-TACE pulmonary complication, lipiodol pneumonitis, is rarely reported. Lipiodol pneumonitis after TACE appears to be associated with chemical injury due to accidental perfusion of lipiodol to the lung vasculature, promoted by arteriovenous shunts within the hypervascular HCC. Here, we report a 42-year-old man with unresectable HCC and hepatic vein thrombosis. The patient was initially treated with TACE. The following day after TACE, acute respiratory symptoms such as dyspnea and cough developed with decreased oxygen saturation. Chest X-ray and computed tomography showed multiple patches and diffuse ground-glass opacities in both lung fields, suggesting of lipiodol pneumonitis. The patient’s condition and radiologic abnormalities subsequently improved after 2 weeks of conservative treatment alone.

Citations

Citations to this article as recorded by

Lipiodol-induced Pneumonitis Following Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma
Heechul Nam
The Korean Journal of Gastroenterology.2022; 80(5): 233. CrossRef

Review Article

An A to Z of Lipiodol Beyond the Clinical Practice in the Management of Hepatocellular Carcinoma: Eileen L. Yoon; J Liver Cancer. 2015;15(2):84-97. Published online September 30, 2015; DOI: https://doi.org/10.17998/jlc.15.2.84

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Abstract PDF: Lipiodol based conventional transarterial chemoembolization (TACE) is a standard of care for unresectable, non-invasive, and multinodular Hepatocellular carcinoma (HCC)s. The procedure relies on the intra-arterial administration of lipiodol/cytotoxic agent emulsion followed by the infusion of embolic material. Lipiodol, with its oily nature and radiopacifying properties, is in the center of the TACE procedure. Unstability and unpredictable therapeutic effect of hydrophilic cytotoxic drugs emulsified in the lipiodol and technical problems lie beyond the control of clinicians. Thus, interest in the properties and respective roles for lipiodol in the management of HCC is essential for the clinicians. (J Liver Cancer 2015;15:84-87)

Original Article

Follow-up of Hepatocellular Carcinoma After Transarterial Chemoembolization; The Concordance of Contrast Enhanced Ultrasonography and Lipiodol CT: Gene Hyun Bok, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim; J Liver Cancer. 2014;14(2):115-119. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.115

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Abstract PDF: Background/Aim
s: The aim of this study is to evaluate the concordance of contrast-enhanced ultrasonography (CEUS) and lipiodol computed tomography (L-CT) for the assessment of viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
Methods
We retrospectively reviewed the post-TACE CEUS and L-CT images of 65 consecutive HCCs in 41 patients to assess the presence of viable tumor tissue. Forty-seven HCCs in 31 patients that underwent post-TACE L-CT within 4 weeks of the CEUS examination were included. The degree of concordance between CEUS and L-CT and factors related to concordance were analyzed.
Results
The overall concordance of CEUS and LDCT was 78.7% (37/47). The concordance with L-CT for viable tumor and non-viable tumor tissue on CEUS was 95.2%, and 65.4% respectively (P<0.013). Diffuse tumors had a tendency for non-concordance (P=0.066). Although 3 of 4 lesions located in the hepatic dome were non-concordant, the sample size was too small to establish significance. The mean tumor size for concordant and non-concordant tumors was 2.9 and 3.0 cm, with no significant difference.
Conclusions
Although the concordance of CEUS and L-CT for viable tumor tissue was high, the concordance for non-viable tumor tissue was relatively low. Prospective studies using angiography as a gold standard should be performed in the future. (J Liver Cancer 2014;14:115-119)

Review Article

A Review on Embolic Materials for Transcatheter Arterial Chemoembolization: Byung Kook Kwak, Hyung Jin Shim; Journal of the Korean Liver Cancer Study Group. 2011;11(1):1-5. Published online February 28, 2011

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Abstract PDF: Four procedures on intraarterial catheter-based therapy are available in treating hepatocellular carcinoma: intraarterial chemotherapy (IAC), transcatheter arterial embolization (TAE), conventional transcatheter arterial chemoembolization (cTACE), and transcatheter arterial chemoembolization using drug-eluting bead (DEB-TACE). On the bases of “2009 Practice Guideline for Diagnosis and Treatment of Hepatocellular Carcinoma” by The Korean Liver Cancer Study Group and National Cancer Center, and “2010 AASLD Practice Guideline” by American Association for the Study of Liver Disease, substances and recommendations on interventional managements were reviewed. Various kinds of embolic materials used in the procedures of TAE, cTACE and DEB-TACE were described in detail.

Case Reports

Treatment of Massive Hepatocellular Carcinoma with Portal Vein Invasion: Jung Hyun Kwon, Jong Young Choi, Jin Dong Kim, Hyun Young Woo, Si Hyun Bae, Seung Kew Yoon, Young Jun Lee, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2009;9(1):53-58. Published online June 30, 2009

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Abstract PDF: A 52 year-old-man patient was admitted for evaluation of hepatic mass which was detected on screening ultrasonography. His abdominal CT showed a massive infiltrating mass in left hepatic lobe and another 2.4 cm nodule in S6 of Rt. Hepatic lobe with arterial enhancement and rapid wash out underlying liver cirrhosis. Also, low density tumor thrombus are filled in Lt. portal vein and extended into main portal vein. He was finally diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class A) and hepatitis B. With the four times of trasnarterial chemo-lipiodolization and seven times of intraarterial infusion chemotherapy for huge mass and one time Radiofrequency ablation (RFA) for daughter nodule, his HCC showed no stain in hepatic angiogram at nine month from initial diagnosis. After additional eight times of intra-arterial infusion chemotherapy, new small nodule developed in S6 and was ablated with RFA. At eighteen months after initial diagnosis, he shows no viable lesion on the imaging study and tumor markers are normalized.

A Case of Advanced Hepatocellular Carcinoma in Twenties Treated by Multimodality Therapy: Jang Eun Lee, Na Ri Yoon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Dong Goo Kim, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Hong Seok Jang, Chan Kwon Jung, Eun Sun Jang; Journal of the Korean Liver Cancer Study Group. 2009;9(1):82-85. Published online June 30, 2009

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Abstract PDF: The prognosis of young patients with hepatocellular carcinoma is remains controversial. Here we report a case of advanced hepatocellular carcinoma in twenty, successfully treated with transarterial chemolipidolization (TACL), systemic chemotherapy, radiation therapy and surgical resection. Previously healthy 28 years old woman was admitted for treatment of hepatocellular carcinoma. Abdominal CT showed a diffuse infiltrative HCC involving both lobes with intrahepatic bile duct invasion and pericardial lymphadenopathy. She was treated TAC with systemic chemotherapy and external beam radiotherapy. 6 months after these treatments, main tumor and the pericardial lymph node were decreased in size. And then extended left lobectomy and systemic chemotherapy were done. The pericardial lymph node was markedly decreased. The patient has been followed for 10 months without evidence of regional tumor recurrence.

Combined hepatocellular and cholangiocarcinoma: Jung Hyun Kwon, Si Hyun Bae, Jung Pil Suh, Ho Sung Park, Chan Ran You, Jong Young Choi, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chan Kwon Chung, Eun Sun Jung, Mi Ryung Ryu; Journal of the Korean Liver Cancer Study Group. 2007;7(1):49-54. Published online June 30, 2007

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Abstract PDF: A 43 year-old-women patient was admitted for one month of jaundice. She was diagnosed hepatitis B carrier 17 years ago and has not done a routine check. Abdominal CT showed a large ill defined mass in left hepatic lobe with inhomogenous enhancement in arterial and delayed phase. The result of biopsy including the immunohistochemical stains showed the combined hepatocellular and cholangiocarcinoma (stage IVa, type C by Allen and Lisa). With the radiation therapy (3,910 cGy), six times of transarterial chemo-lipiodolization and two times of percutaneous ethanol injection, huge mass was markedly decreased in size and no stain in hepatic angiogram. She underwent left lobectomy.

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