Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has become an effective alternative treatment strategy for patients with inoperable hepatocellular carcinoma (HCC). Although TACE is relatively safe, pulmonary lipiodol embolism is a rare and potentially fatal complication which is often not anticipated by physicians. About 14 patients with pulmonary lipiodol embolism progressing to respiratory distress were reported in previous literature. Here, we report a patient with HCC who survived a severe pulmonary lipiodol embolism requiring mechanical ventilatory support and uneventfully received the second course of TACE. In this article, we sum previous literature and have discussed the possible pathophysiological mechanism underlying this complication and risk factors for its development.