Abstract
Background Acute lung injury (ALI) is a rare but life-threatening pulmonary complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The aim of this study was to characterize the common risk factors, clinical features, imaging findings, treatments, and outcomes of acute lung injury caused by TACE. Methods A retrospective study was performed on all TACE-associated ALI cases that were diagnosed at authors' hospital from January 2015 to June 2018. Results The study included 14 ALI cases where the mean age of patients was 60.9 ± 11.7 years (range 41-82 years), with a mean onset time of 2.4 ± 1.6 d after TACE. Of the 14 patients, 8 patients (57.1%) developed acute respiratory distress syndrome (ARDS). 7 patients (50%) had underlying chronic respiratory disease and hepatic arteriovenous fistula was detected in 6 patients (42.6%), both of which were significantly higher than control group (P < 0.05). Dyspnea (92.9%) was the most common symptoms. Pleural effusion (64.3%), diffuse pulmonary infiltration (42.9%), and accumulation of Lipiodol in lung field (42.9%) were frequent radiologic abnormalities. 11 patients (78.6%) achieved remission after treatment, and the 30-day mortality rate was approximately 21.4%. Patient's median survival time after the development of ALI was merely 4.3 months, which was obviously worse than control group (4.3 months vs. 13.5 months, P < 0.05). Conclusion This study illustrates that TACE-associated ALI is a rare pulmonary complication with a high mortality rate. We infer that pulmonary Lipiodol embolization might be one of the main causes of TACE-associated ALI. Thus, HCC patients who are at high risk should be closely evaluated and monitored during TACE to avoid such potentially fatal complication.
Highlights
Hepatocellular carcinoma (HCC), the most common primary hepatic malignancy, is a leading cause of cancerrelated death in the world, and more than 80% of the cases occur in Asia due to the prevalence of chronic hepatitis [1, 2]
During the study period (January 2015 to June 2018), we identified 32 patients with pulmonary complication after transcatheter arterial chemoembolization (TACE) and 14 patients (10 female and 4 male) met the diagnostic criteria of Acute lung injury (ALI) were included
The combination of chronic respiratory disease or hepatic arteriovenous fistula were significantly common in patients with ALI (P < 0:05), which could be considered as risk factors for the development of ALI following TACE
Summary
Hepatocellular carcinoma (HCC), the most common primary hepatic malignancy, is a leading cause of cancerrelated death in the world, and more than 80% of the cases occur in Asia due to the prevalence of chronic hepatitis [1, 2]. Conventional TACE uses an emulsion of Lipiodolchemotherapeutic agent, whereas TACE with drug-eluting beads (DEB-TACE) uses beads loaded with a chemotherapeutic agent such as doxorubicin Both two regimens have been shown to achieve a significant survival benefit according to previous researches [4, 5]. Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized as the acutely development, bilateral pulmonary infiltrates and severe hypoxemia. Acute lung injury (ALI) is a rare but life-threatening pulmonary complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The aim of this study was to characterize the common risk factors, clinical features, imaging findings, treatments, and outcomes of acute lung injury caused by TACE. This study illustrates that TACE-associated ALI is a rare pulmonary complication with a high mortality rate. HCC patients who are at high risk should be closely evaluated and monitored during TACE to avoid such potentially fatal complication
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