Computed tomography demonstration of portal venous gas after hepatic artery embolization

A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

Hepatic portal venous gas (HPVG) refers to the imaging signs formed by the abnormal accumulation of abnormal gas in the portal veins and the branches of the inner veins of the liver due to various reasons, and is usually associated with poor prognosis. HPVG is mostly caused by abdominal diseases. Herein, we reported a patient with hepatocellular carcinoma developed HPVG following transcatheter arterial chemoembolization (TACE). This patient was identified as Barcelona Clinic Liver Cancer (BCLC) stage B, and treated by five times of TACE. Gelfoam sponge was used as embolic agent in the first and last TACE treatment. After the first TACE, pneumonia occurred in the right lung, and pneumorachis with iodine oil deposition occurred in the tumor lesion in the right lobe of the liver, which was considered as hepatic abscess. After three more TACE, enhanced MRI showed significant necrosis and reduction of the lesions. After the fifth TACE, the enhancing computed tomography (CT) showed a large amount of gas in the lesions and in the portal veins, which was considered as HPVG. Although after active treatment, the patient died soon. To our knowledge, this is the first case report of a patient with hepatocellular carcinoma developed HPVG following TACE with gelfoam sponge as embolic agent.

Hepatic artery embolization for neuroendocrine tumors: postprocedural management and complications

BACKGROUND

There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors.

METHODS

Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging.

RESULTS

In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins.

CONCLUSIONS

The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patients could exclusively receive oral analgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.

Ex vivo magnetic resonance imaging of pretransplant human donor liver. Clinical experience in 66 cases

Magnetic resonance imaging (MRI) was performed on 66 cold-stored human donor livers. Spin echo images were obtained with a clinical whole body MRI system. Various parenchymal and vascular abnormalities were found. An unexpected finding was the abundant presence of intrahepatic air. Although the majority of parenchymal abnormalities that were found would not have precluded transplantation, the rationale of pretransplant MRI was to prevent the introduction of unidentified pathology into the recipient. Guided by the MR images, lesions in the isolated organ can be easily located for biopsy and resection. Unnecessary or inadequate therapeutic interventions after transplantation can thus be avoided. In addition, the visualization of the hepatic veins with their confluence appears to be useful in split-liver procedures.