Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4291
Peer-review started: July 16, 2018
First decision: August 1, 2018
Revised: August 4, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: October 7, 2018
A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma (HCC). Even after the injection of 7 mL of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient’s level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient’s level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.
Core tip: Vascular lakes that resemble extravasation within hepatocellular carcinomas occasionally emerge during chemoembolization. To date, the drainage routes from vascular lakes are not well understood. We present a patient with a recurrent large hepatocellular carcinoma in which a vascular lake emerged during conventional chemoembolization, draining into systemic veins and causing pulmonary and cerebral lipiodol embolism.