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Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia

Published online by Cambridge University Press:  16 August 2006

K. Yamaura ,
M. Higashi ,
K. Akiyoshi ,
Y. Itonaga ,
H. Inoue  and
S. Takahashi
K. Yamaura
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
M. Higashi
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
K. Akiyoshi
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
Y. Itonaga
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
H. Inoue
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
S. Takahashi
Affiliation:
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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Abstract

We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.

Keywords

radiologyinterventionalembolismpulmonary embolismcontrast mediaiodized oilmonitoringintraoperativepulse oximetryintraoperative complicationspulmonary embolism
Type
Clinical Letter
Information
European Journal of Anaesthesiology , Volume 17 , Issue 11 , November 2000 , pp. 704 - 708
Copyright
2000 European Society of Anaesthesiology

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