Lipiodol-Induced Pneumonitis and Cerebral Embolism After Transarterial Chemoembolization for Hepatocellular Carcinoma—A Case Report

Hepatocellular carcinoma (HCC) typically develops in individuals who have liver cirrhosis because of various causes. Transarterial chemoembolization (TACE) was first introduced in 1977 as a method of treating HCC. This involved injecting chemotherapy drugs into gelatin sponges via the hepatic artery. In the 1980s, lipiodol, an ethiodized oil, became the standard agent used in conventional TACE. In this case, we report an interesting complication of the TACE procedure that is under published in the Middle East. A 65-year-old woman with preexisting diabetes, hypertension, and dyslipidemia underwent TACE for newly diagnosed HCC. While the first session using doxorubicin and lipiodol was successful, a cascade of complications occurred after the second TACE session. After she was admitted to Al-Amiri Hospital's ICU (Kuwait) with an initial suspicion of acute respiratory distress syndrome (ARDS), her condition rapidly deteriorated to include hypoxia, mechanical ventilation requirements, and altered consciousness. Extensive imaging revealed the cause of her disease: lipiodol-induced pneumonitis and cerebral lipiodol embolism (CLE), which are rare and serious complications. After dedicated intensive care management and conservative treatment, she made a remarkable recovery and eventually returned home. This case highlights the rare but potentially devastating complications of lipiodol-induced pneumonitis and CLE associated with TACE in HCC treatment. Despite successful first-line therapy, underlying comorbidities and risk factors, such as female sex and advanced age, may increase the risk of CLE after subsequent procedures. Careful patient selection, meticulous procedural techniques, and vigilant postprocedural monitoring are crucial for minimizing this risk. While our patient’s remarkable recovery emphasizes the potential for successful management, it underscores the importance of heightened awareness and proactive measures to prevent this serious complication in future TACE procedures.