Hemorrhage Following Drug-Eluting Bead Transarterial Chemoembolization of Hepatocellular Carcinoma

We report the case of a 78-year-old woman with hepatocellular carcinoma who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE). On the first routine follow-up CT six-weeks post procedure, the patient was found to have residual enhancing tumor and active intra-tumoral hemorrhage (Fig 1A). Follow-up laboratory values demonstrated a decrease in hemoglobin. Subsequent catheter arteriogram confirmed active arterial hemorrhage as well as enhancement along the periphery, suggestive of residual tumor, which was treated with repeat embolization (Fig. 1B). Several arteries supplying the residual tumor were embolized using drug eluting bead transcatheter chemoembolization (DEB-TACE). Additionally, the active arterial extravasation was treated with 0.018” coil embolization using platinum microcoils achieving post-embolization hemostasis (Fig. 1C). Nine-month follow up imaging demonstrated no residual enhancing tumor or evidence of active extravasation of contrast material (Fig. 1D).