A lethal complication after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

Abstract

Background. The current standard of care for patients with large or multinodular noninvasive hepatocellular carcinoma is conventional transarterial chemoembolization (TACE). TACE may also be performed with drug-eluting beads, but serious complications of this procedure have been reported. Methods. Aim of this report is to present a patient affected by multifocal HCC who underwent TACE with drug-eluting bead (DEB-TACE). Results. Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death. Conclusion. We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area. This activity that can extend to the surrounding healthy hepatic tissues may continue indefinitely.

Figure 1

Pretreatment CT scan (a) CT image showing the main tumor in the right lobe of the liver at the confluence of the right and middle hepatic veins measuring 42 × 35 mm. (b) CT-image in the arterial phase showed the second lesion in segment 4 measuring 12 mm in diameter.

Figure 2

CT image at 28 d after TACE with DC beads. (a) CT image showing a huge abscess in the right lobe of the liver. (b) Many small hypodense areas are located mostly in segments 4, 6, 7, and 8 of the liver.

Figure 3

CT scan before presenting to our emergency room with bilioptysis and fever. (a) There is a huge fluid collection adjacent to the dome of the right lobe of the liver. (b) Multiple abscesses are scattered throughout the right lobe of the liver.