Published online Nov 28, 2016. doi: 10.5320/wjr.v6.i3.69
Peer-review started: April 27, 2016
First decision: June 17, 2016
Revised: July 27, 2016
Accepted: August 17, 2016
Article in press: August 18, 2015
Published online: November 28, 2016
Transcatheter arterial chemoembolization (TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma (HCC). Post-TACE pulmonary complications resulting in acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous (AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.
Core tip: Pulmonary complications after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) are thought to be related to chemical injury caused by the infused ethiodized oil or chemotherapeutic agent, which can migrate to the lung vasculature via arteriovenous (AV) shunts associated with the hyper-vascular HCC. The risk factors associated with post-TACE pulmonary complications include large hyper-vascular HCC, AV shunts, large volume of Lipiodol, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. Careful monitoring of patients perioperatively and an awareness of the potential post-TACE pulmonary complications should expedite early recognition and effective management of these patients.