대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary Oil Embolization after Transcatheter Oily Chemoembolization

Radiologic Findings

Chest PA: Diffuse, bilateral pulmonary infiltrates in the whole lungs. Hepatic mass containing lipiodol is seen in right subphrenic area.
HRCT: Patchy ground glass opacities are diffusely noted in the entire lungs, esp. at the nondependent portions of upper lobes. CECT scan shows radioopaque, embolized mass in the right hepatic dome.

Brief Review

Transcatheter oily chemoembolization (TOCE) with a mixture of iodized oil (Lipiodol) and an anticancer drug has been increasingly used in the conservative management of hepatocellular cell carcinoma. Retention of iodized oil was shown essentially within two organs, the liver and the lungs. Symptoms, and signs (dyspnea, hemoptysis and cough), radiographic manifestations (diffuse bilateral infiltrate), and the clinical course were most severe 2-10 days after TOCE. Two to 4 days after IV injection of the oil in rabbits, hypoxemia was most severe and was accompanied by extensive alveolar and interstitial inflammation, hemorrhage, and edema. The most likely mechanism by which iodized edema is the chemical injury due to its component fatty acids. The time required to reach toxic concentrations of these fatty acids might thus be responsible for the delayed onset and the slow release from the tumor into the pulmonary circulation might be an other cause of the delayed onset. Fallat et al observed slower clearance of iodized oil from the upper lungs . In one report, the upper lung infiltrate was intensified despite of the disappearance of opacity in the lower lung. Overt pulmonary embolization developed, when more than 20 mL of oil was used. HRCT findings in this case showing diffuse ground glass opacities, particularly in the nondependent portions of the upper lungs were similar to those of fat embolism syndrome

References

1. Chung JW, Park JH, Im JG, Han JK, Han MC. Pulmonary oil embolization after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 1993;187:689-693
2. Fallat RJ, Powell MR, Youker JE, Nadel JA. Pulmonary deposition and clearance of 131I-labeled oil after lymphangiography in man: correlation with lung function. Radiology 1970;97:511-520
3. Choi JA, Oh YW, Kim HK, Kang KH, Choi YH, Kang EY. Nontraumatic pulmonary fat embolism syndrome: Radiologic and pathologic correlations. Journal of Thoracic Imaging 2002;17:167-169

Keywords

Vascular, Lung, Iatrogenic lung disease, embolism,