Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3625-3630
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3625
Non-target lung embolization during portal vein embolization due to an unrecognized portosystemic venous fistula: A case report
Sultan R Alharbi, Mohammed Bin Nasif, Haifa Bandar Alwaily
Sultan R Alharbi, Interventional Radiology Unit, Department of Radiology, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh 11362, Saudi Arabia
Mohammed Bin Nasif, Haifa Bandar Alwaily, Department of Radiology, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
Author contributions: Alharbi SR did the procedure and wrote and revised the manuscript; Bin Nasif M did the literature review and made the references summary; Alwaily HB collected the reviewed the clinical and follow-up patient data.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sultan R Alharbi, MD, Associate Professor, Doctor, Interventional Radiology Unit, Department of Radiology, College of Medicine, King Saud University, King Khalid University Hospital, PO Box 7805, King Abdullah Street, Riyadh 11362, Saudi Arabia.
Received: January 14, 2023
Peer-review started: January 14, 2023
First decision: January 30, 2023
Revised: February 14, 2023
Accepted: April 13, 2023
Article in press: April 13, 2023
Published online: May 26, 2023

Portal vein embolization (PVE) is an effective and relatively safe procedure performed prior to major hepatic resection to enhance future liver remnant. Non-target embolization during PVE is rare, and if it occurs, it usually affects the future liver remnant. Intrahepatic portosystemic venous fistulas are extremely rare in non-cirrhotic livers. We report a case of non-targeted lung embolization during PVE due to an unrecognized intrahepatic portosystemic fistula.


A 60-year-old male presented with metastatic colon cancer of the liver. The patient underwent preoperative right PVE. During the embolization procedure, a small amount of glue and lipiodol emulsion was embolized to the heart and lungs through an unrecognized intrahepatic portosystemic fistula. The patient remained clinically stable and underwent the planned hepatic resection after 4 wk, with an uneventful postoperative course.


Conventional portograms and careful evaluation prior to PVE are advisable to avoid such complications.

Keywords: Portal vein embolization, Non-target embolization, Portosystemic venous fistula, Case report

Core Tip: Portal vein embolization (PVE) is relatively safe procedure done prior to major hepatic resection to enhance the future remnant liver. Intrahepatic portosystemic venous fistula is very rare in non-cirrhotic liver. Non-target embolization is a rare complication of such a procedure. This is the first case report of non-target lung embolization during PVE through a portosystemic venous fistula. Failure of recognition of this rare vascular abnormality led to this rare complication. In our case, we emphasize on careful evaluation of conventional portogram prior to PVE to avoid such complication.