Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2018; 24(37): 4291-4296
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4291
Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature
Hideki Ishimaru, Minoru Morikawa, Takayuki Sakugawa, Ichiro Sakamoto, Yasuhide Motoyoshi, Yohei Ikebe, Masataka Uetani
Hideki Ishimaru, Minoru Morikawa, Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
Takayuki Sakugawa, Department of Radiology, University of the Ryukyus, Okinawa 903-0213, Japan
Ichiro Sakamoto, Department of Radiology, Nagasaki Harbor Medical Cancer, Nagasaki 850-8555, Japan
Yasuhide Motoyoshi, Department of Gastroenterology, Nagasaki Harbor Medical Cancer, Nagasaki 850-8555, Japan
Yohei Ikebe, Masataka Uetani, Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
Author contributions: Ishimaru H, Morikawa M, and Sakamoto I designed the report; Sakugawa T and Motoyoshi Y collected the patient’s clinical data; Ishimaru H, Ikebe Y, and Uetani M wrote the paper.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Minoru Morikawa, MD, Assistant Professor, Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Telephone: +81-95-8197354 Fax: +81-95-8197357
Received: July 16, 2018
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
Case characteristics

A 63-year-old man with a large hepatocellular carcinoma underwent transcatheter arterial chemoembolization (TACE), but his level of consciousness deteriorated immediately after the procedure.

Clinical diagnosis

CT scan of the brain revealed multiple lesions of increased attenuation, and cerebral lipiodol embolism (CLE) was confirmed.

Differential diagnosis

There is no differential diagnosis.

Laboratory diagnosis

No specific finding was obtained by laboratory testing.

Imaging diagnosis

An angiography during TACE procedure revealed a newly developed vascular lake draining into systemic veins, which offered a pathway carrying lipiodol to pulmonary vessels and was the most likely cause of this serious complication.

Pathological diagnosis

No pathological examination was performed.


The patient was treated in our intensive care unit.

Related reports

This is the first report of CLE, in which vascular lake phenomenon emerging during the procedure caused intratumoral arteriovenous shunt and played the most important role for its occurrence.

Term explanation

The term CLE describes cerebral lipiodol embolism.

Experiences and lessons

Arteriovenous shunt via vascular lake may develop during chemoembolization, repeated angiography during TACE procedures should be performed to prevent CLE, especially when it is difficult to obtain a decrease of blood flow.