Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature

Figure 1 Angiography. A: Selective angiography of the left inferior phrenic artery shows feeding of the anterior part of the tumor without a shunt to the pulmonary vasculature; B: Angiography during glue embolization shows no influx into the pulmonary vasculature.

Figure 2 Infused 140 mg of miriplatin suspended in 7 mL of lipiodol via the left hepatic artery. A: Left hepatic angiography shows a large hypervascular tumor in the left hepatic lobe and intrahepatic metastases neighborhood without an intratumoral AV shunt; B: Repeated left hepatic angiography shows a vascular lake in the superior portion of the tumor (arrow) that developed after chemoembolization; C: Venous phase shows drainage into the pericardiacophrenic vein (arrow heads), which was unrecognized until remasking and pixel shifting were performed. AV: Arteriovenous.

Figure 3 Non-contrast brain computed tomography scan obtained 30 min after chemoembolization shows multiple increased attenuated lesions in the bilateral cerebral hemisphere, consistent with lipiodol embolism.

Figure 4 Chest computed tomography scan obtained 30 min after chemoembolization shows lipiodol deposition at both lung bases.