Ichikawa T, Yamada T, Takagi H, Abe T, Ito H, Sakurai S, Nagamine T, Mori M
Department of Gastroenterology, Maebashi Red Cross Hospital, Japan.
J Gastroenterol. 1997 Jun;32(3):405-9. doi: 10.1007/BF02934501.
A 52-year-old man with hepatocellular carcinoma (HCC) was admitted with cough and fever. He had undergone four series of treatments, including transcatheter embolization and chemoembolization with lipiodol and anticancer drugs, over the previous 2 years. Computed tomography demonstrated dilated hepatic ducts, localized necrosis in the right hepatic lobe, and subphrenic abscess. He died of respiratory failure, because of increased effusion of the right pleura, about 3 weeks after admission. Autopsy revealed adhesions in the lower lobes of the right lung, diaphragm, and liver, with granulomas with bile pigment. A fistula was observed from the necrotic regions of the right hepatic lobe to the pleura through the diaphragm. A tumor thrombus in the portal trunk was histologically confirmed as well and moderately differentiated HCC with trabecular arrangement. Direct invasion of HCC with necrotic tissue to the pleura through the diaphragm appeared to have caused the respiratory failure. Although bilious pleuritis is a rare complication of transcatheter arterial embolization (TAE), it should be considered as an adverse effect of TAE in patients with a dilated hepatic duct.
一名52岁的肝细胞癌（HCC）男性患者因咳嗽和发热入院。在过去2年中，他接受了包括经导管栓塞以及使用碘油和抗癌药物进行化疗栓塞在内的4个疗程的治疗。计算机断层扫描显示肝内胆管扩张、右肝叶局部坏死以及膈下脓肿。入院约3周后，他因右胸膜积液增多死于呼吸衰竭。尸检发现右肺下叶、膈肌和肝脏存在粘连，伴有含胆色素的肉芽肿。观察到从右肝叶坏死区域通过膈肌至胸膜的瘘管。门静脉主干内的肿瘤血栓经组织学证实，为具有小梁状排列的中度分化HCC。HCC坏死组织经膈肌直接侵犯至胸膜似乎是导致呼吸衰竭的原因。尽管胆汁性胸膜炎是经导管动脉栓塞术（TAE）的一种罕见并发症，但对于肝内胆管扩张的患者，应将其视为TAE的一种不良反应。
