Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome

Abstract

Objective: The present study aims to analyze the clinical characteristics and etiology of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) complicated with acute respiratory distress syndrome (ARDS), in order to improve the early diagnosis rate and cure rate.

Methods: A total of 816 patients with primary HCC received 2,200 TACE treatments from January 2014 to May 2018. Among these patients, 6 patients developed ARDS after TACE. The clinical data, lesion characteristics, laboratory tests, treatment process and prognosis of 6 patients were retrospectively analyzed.

Results: The longest lesion diameter ranged within 5.0-10.2 cm (mean: 6.6 cm) in the 6 patients with primary HCC. Among these patients, 4 patients had lesions mainly located in the left lateral lobe of the liver, while 5 patients had no hepatic arteriovenous fistula detected before TACE. Nedaplatin, epirubicin and iodinated oil suspension chemoembolization were used in all 6 patients during TACE, and all of them experienced ARDS symptoms within 24-48 hours after TACE. However, no clear pathogenic bacteria were incubated in the sputum culture after the onset of the disease. Diffused exudative changes of both lungs were found in the chest X-ray, and the oxygenation index (PaO₂/FiO₂) was within 100-300 mmHg. The symptoms of 6 patients improved after 3-6 days of hormone therapy.

Conclusion: In this study, we found that although the incidence of ARDS after TACE was low in the treatment for HCC, the symptoms after onset were serious, and the early hormone therapy may be beneficial to improve the prognosis and reduce mortality. Further research with larger samples is still needed to confirm the pathogenesis of ARDS after TACE in the treatment for HCC.

Keywords: acute respiratory distress syndrome; hepatocellular carcinoma; lipiodol embolism; pneumonia; transcatheter arterial chemoembolization.

Figure 1.

Male, 35 years old, with sudden chest tightness, shortness of breath, dyspnea and large amount of sputum 32 hours after TACE. A: Reexamination of chest radiographs suggested a change in bilateral pulmonary exudation. B: Symptoms did not improve significantly on the third day after meropenem anti-infection treatment, and chest radiographs showed significant progress in bilateral pulmonary exudation. C: On the third day after the anti-inflammatory treatment of methylpredinone, the chest radiograph showed that the exudation in both lungs was significantly improved compared with the previous absorption.