Nontarget embolization complicating transarterial chemoembolization in a patient with hepatocellular carcinoma

Abstract

Nontarget embolization during transarterial chemoembolization, although infrequent, can be a serious complication. The authors describe a case of nontarget gastric embolization to the stomach after transarterial chemoembolization and describe the published incidence of nontarget embolization to various organs, its diagnosis, treatment, and possible outcomes.

Keywords: Chemoembolization; hepatocellular carcinoma.

Figure 1

Axial contrast medium-enhanced T1-weighted fat-saturated magnetic resonance image demonstrates multiple small, ill-defined, arterially enhancing lesions in the left hepatic lobe. The lesions demonstrated washout on delayed images, consistent with hepatocellular carcinoma.

Figure 2

Digital subtraction angiogram with a reverse-curve catheter positioned in the celiac trunk demonstrates conventional celiac artery anatomy.

Figure 3

Digital subtraction angiogram with a microcatheter in the proximal left hepatic artery demonstrates multiple branches off the left hepatic artery. Chemoembolization was performed at this position.

Figure 4

Angiogram with a microcatheter in the proper hepatic artery after chemoembolization had been performed demonstrates contrast within all hepatic branches. Additionally, there is increased density within the stomach, consistent with Ethiodol^® uptake.

Figure 5

Noncontrast axial (A) computed tomography scans with coronal reconstruction (B) show distribution of Ethiodol^®, which is present in the left hepatic lobe, caudate lobe, and the gastric rugae.