在药物洗脱微球经动脉化疗栓塞过程中,因疑似过敏性休克而中断操作时,需要对血管湖现象的发展进行仔细随访。

Interruption during drug-eluting beads transarterial chemoembolization procedure by presumed allergic shock requires careful follow-up on the development of vascular lake phenomenon.

作者信息

Ogawa Akihiro, Wada Yuki, Iijima Katsunori, Mori Naoko

机构信息

Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan.

Division of Gastroenterology, Hepato-biliary-pancreatology and Neurology, Akita University Graduate School of Medicine, Akita, Japan.

出版信息

J Clin Imaging Sci. 2024 Jul 31;14:27. doi: 10.25259/JCIS_47_2024. eCollection 2024.

Abstract

We present a case involving a 60-year-old male with multifocal hepatocellular carcinoma (HCC), emphasizing the critical need for vigilant post-procedural monitoring following the interruption of drug-eluting beads transarterial chemoembolization (DEB-TACE) due to an allergic reaction. The patient, who had a history of various treatments for HCC, underwent DEB-TACE. During the procedure, he experienced an anaphylactic shock, presumably due to an allergy to the treatment components (iodinated contrast agent), resulting in the procedure's discontinuation. Initially stable, the patient was later found to have intra-abdominal bleeding, a complication associated with the vascular lake phenomenon (VLP), detected on post-procedural imaging. Re-embolization using gelatin particles was performed to address the VLP. It remains unclear whether the shock experienced during the DEB-TACE procedure was due to the allergic reaction or the rupture of the VLP. This case underscores the complexities in managing DEB-TACE, the necessity of careful monitoring for VLP, and the challenges in diagnosing and managing allergic reactions during such procedures. In conclusion, it is crucial to consider that VLP can occur at any time during or after DEB-TACE. Assessing the presence of VLP using digital subtraction angiography before the termination of the procedure is essential. However, when an allergy to the iodinated contrast agent is suspected, as in this case, careful follow-up with abdominal ultrasound and computed tomography might be necessary to assess the presence of intra-abdominal hemorrhage associated with VLP.

摘要

我们报告了一例涉及一名60岁多灶性肝细胞癌(HCC)男性患者的病例,强调了在因过敏反应中断载药微球经动脉化疗栓塞术(DEB-TACE)后进行密切术后监测的迫切需求。该患者有多种肝癌治疗史,接受了DEB-TACE治疗。在手术过程中,他发生了过敏性休克,推测是对治疗成分(碘化造影剂)过敏,导致手术中断。患者最初情况稳定,但后来在术后影像学检查中发现有腹腔内出血,这是一种与血管湖现象(VLP)相关的并发症。使用明胶颗粒进行了再次栓塞以处理VLP。目前尚不清楚DEB-TACE手术期间发生的休克是由于过敏反应还是VLP破裂所致。该病例凸显了DEB-TACE管理中的复杂性、对VLP进行仔细监测的必要性以及在此类手术中诊断和管理过敏反应的挑战。总之,必须认识到VLP可能在DEB-TACE期间或之后的任何时间发生。在手术结束前使用数字减影血管造影评估VLP的存在至关重要。然而,如本病例一样,当怀疑对碘化造影剂过敏时,可能需要通过腹部超声和计算机断层扫描进行仔细随访,以评估与VLP相关的腹腔内出血情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b630/11301803/2bbd312383be/JCIS-14-27-g001.jpg

相似文献

本文引用的文献

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索