Pulmonary embolism: a fatal complication of arterial chemoembolization for advanced hepatocellular carcinoma

The case of a child with advanced hepatocellular carcinoma that did not respond to systemic chemotherapy is presented. Three courses of chemoembolization (hepatic arterial chemoembolization) were given, with partial tumor response. The hepatic artery was cannulated via the femoral artery using the Seldinger technique. Arteriography was performed, and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with Lipiodol) was injected. After the third hepatic arterial chemoembolization, the patient developed fatal pulmonary oil embolism. Hepatic arterial chemoembolization seems to be a useful method for treatment of high-risk hepatocellular carcinoma cases, which can induce responses, even in metastatic patients refractory to standard systemic chemotherapy. However, it may result in pulmonary embolism, which is a potentially fatal complication. In children, Lipiodol should be used as an embolizing material and cytostatic carrier with extreme care. Consideration should be given to replacing it with other materials, including albumin or collagen.