Although acute hepatic failure (AHF) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is not a rare complication, the development of spontaneous bacterial peritonitis (SBP) is uncommon. We describe two cases who suffered SBP and AHF right after TACE for HCCs. In the first case, 5 days after TACE ascites and jaundice newly developed and SBP was diagnosed at 9 days after TACE. After use of secondary antibiotics (imipenam) due to failure of primary therapy with 3rd cephalosporin, he discharged with resolution of SBP. In the second case, jaundice, abdominal pain and fever developed with increased ascites 3 days after TACE. After 8 days, SBP was diagnosed and treated with imipenam due to primary treatment failure, but clinical course was deteriorated. Eighteen days after discharge, she died of AHF. In patients with increased ascites and fever after TACE, clinician should be considered SBP with AHF among post-TACE complications, and prompt management is needed.
Transcatheter arterial chemoembolization (TACE) is one of the most effective treatments for patients with inoperable
hepatocellular carcinoma (HCC). However, variable complications can occur after TACE. Complications resulting from TACE
contain postembolization syndrome, liver abscess, bile duct injury, ruptured HCC, acute hepatic failure, variceal bleeding, acute
kidney injury, pulmonary lipiodol embolization, femoral artery pseudoaneurysm, femoral arteriovenous fistula, abdominal aortic
dissection, spinal cord injury, and others. Complications after TACE are occasionally fatal. Therefore, it is important that we are
well acquainted ourselves with these complications, and need care promptly the patient who develop symptoms of complication.
Hepatocellular carcinoma (HCC) is the fourth most common cancer in Korea and a common cause of cancer death.
Transcatheter arterial chemoembolization (TACE) is used as palliative therapy for patients with inoperable HCC. TACE is an
effective treatments for inoperable HCC, but variable complications due to using embolic agents can occur after TACE.
Complications due to embolic agents include pulmonary lipiodol embolism, splenic infarction, cerebral lipiodol infarction, and
spinal cord injury. This is a rare case of spinal cord injury after a sixth TACE via right T9 intercostal artery.
Advanced hepatocellular carcinoma has a poor prognosis, especially in the cases with portal vein or IVC tumor
thrombi. In such cases, surgical resection could not be a curative treatment option and transcatheter arterial
chemoembolization (TACE) alone is usually ineffective. Recently, three-dimensional conformal radiation therapy
(3D-CRT) has been developed to better conform the radiation dose to the tumor volume in order to reach the goal
of eradicating local disease without injuring normal tissue. Combination therapy with TACE and 3D-CRT could
be considered as a treatment option for advanced HCC with PV or IVC tumor thrombi. We report here two cases
with advanced HCC showing response to combination therapy with repeated TACE and 3D-CRT.
A 46 year-old male patient was admitted to our hospital for evaluation of hepatic mass which was detected on
ultrasonography. He had a history of chronic hepatitis B carrier. Laboratory findings showed that HBsAg was
positive, and HBeAg was negative. AFP was 2,081.1 ng/mL. Abdomen CT showed a large well-defined low
density lesion involving entire right hepatic lobe which was compatable with advanced hepatocellular carcinoma
(stage III). Celiac and hepatic arteriogram reveled huge hypervascular mass at both lobe of the liver.
Transcatheter arterial chemoembolization (TACE), systemic chemotherapy, percutaneous ethanol injection therapy
(PEIT), and radiotherapy were combined as the treatment of huge hepatoma. After combined therapy, tumor
decreased in size. As a result, curative right lobectomy could be performed. Six months after surgery, chest CT
showed two small metastatic nodules in both lung, so wedge resection was performed. We followed the patient
for 5 years after operation and there was no evidence of regional tumor recurrence or distant metastasis.
Surgical resection is not candidate for advanced stage hepatocellular cacinoma with portal vein thrombosis, but
transcatheter arterial chemoembolization (TACE) or radiotherapy can be considered as palliative treatment option.
We experienced a 44-old-male who has stage Ⅳa hepatocellular carcinoma. We performed TACE and 3-dimensional
conformal radiotherapy for hepatocellular carcinoma and portal vein thrombosis. Because follow up image
study showed no viable tumor, we then performed surgical resection. Surgical specimen also showed complete
tumor necrosis.
Transcatheter arterial chemoembolization(TACE) is an effective treatment method in the management of patients with inoperable hepatocellular carcinoma. The effectiveness of TACE, however, is decreased, when arterioportal shunt is present, since embolic and chemotherapeutic agents are diverted from the tumor to the normal parenchyma through branches of the portal vein. In such case, TACE may not only be ineffective, but also cause hepatic infarction followed by hepatic failure. We report a case of hepatocellular carcinoma with arterioportal shunt, successfully treated by TACE.
A 52-year-old male was referred to our hospital for further evaluation and treatment of known hepatocelluar carcinoma. He did not have risk factors for hepatocellular carcinoma, such as hepatitis virus infection, alcohol abuse and occupational history. We performed CT scan that showed a single nodule with a diameter of 4 cm in the segment Ⅴ. MR imaging showed the same nodule in the segment Ⅴ without any additional nodule in the liver. We performed segmentectomy for the segment Ⅴ, Ⅵ, and Ⅶ. Five months later, follow-up CT scan showed disseminated hypervascular nodules involving the remaining liver. Hepatic angiography also showed multiple hypervascular nodules in the remaining liver, indicating early recurrence by intrahepatic metastasis. We then performed transcatheter arterial chemoembolization (TACE). At present, this patient underwent TACE for ten times, but was still found to have new intrahepatic metastases, tumor invasion to the portal vein and lymph node metastasis in the peripancreatic area.
A large nodular hepatocellular carcinoma located at the anterior superior portion of the left lobe was treated with transcatheter arterial chemoembolization through the left hepatic artery. Three months later, however, there was a re-elevation of the serum alpha-fetoprotein level and an evidence of a marginal recurrence at the left side of the previously embolized tumor was noted on the postembolizeation computed tomographic scan. Although the hepatic artery was intact in the second hepatic arteriography, we found that the right internal mammary artery was feeding the recurred hepatocellular carcinoma. Right internal mammary artery was successfully treated with Lipiodol-transcatheter arterial chemoembolization. However, an ischemic lesion occurred in the skin of the anterior chest and abdominal wall several days after the embolization of the internal mammary artery.
We report here a very rare case of ischemic skin lesion on the anterior chest and abdominal wall following transcatheter arterial chemoembolization of the right internal mammary artery. This internal mammary artery was embolized because it had developed a collateral tumor feeding vessel following the initial chemoembolization of a hepatocellular carcinoma.