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Semin intervent Radiol 2015; 32(01): 010-013
DOI: 10.1055/s-0034-1396957
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cerebral Embolization of Ethiodized Oil following Intranodal Lymphangiography

Arman Sheybani
1   Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
,
Ron C. Gaba
1   Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
,
Jeet Minocha
1   Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
› Author Affiliations
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Publication Date:
02 March 2015 (online)

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Abstract

Intranodal lymphangiography (IL) has supplanted pedal lymphangiography (PL) as an easier and more practical approach to opacifying lymphatic vessels for interventional radiologists treating refractory chyle leaks. As more interventional radiologists—many of who are not trained in or have not performed PL—incorporate IL into their practice, it is imperative that they be familiar with the risks of lymphangiography, including pulmonary and systemic embolization of oily contrast material. Herein, the authors report a devastating case of cerebral embolization of ethiodized oil following IL and review the literature regarding systemic embolization following lymphangiography.

Keywords

interventional radiology - stroke - complication - lymphangiogram
 

  • References

  • 1 Rajebi MR, Chaudry G, Padua HM , et al. Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 2011; 22 (9) 1300-1305
    CrossrefPubMedSearch in Google Scholar
  • 2 Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012; 23 (5) 613-616
    CrossrefPubMedSearch in Google Scholar
  • 3 Strijk SP, Boetes C, Rosenbusch G, Ruijs JH. Lymphography and abdominal computed tomography in staging Hodgkin's disease. Rofo 1987; 146 (3) 312-318
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002; 13 (11) 1139-1148
    CrossrefPubMedSearch in Google Scholar
  • 5 Emınler AT, Ayyildiz T, Irak K, Dolar E. Tuberculous peritonitis case at advanced age presenting with chylous ascites. Turk J Gastroenterol 2012; 23 (4) 423-425
    PubMedSearch in Google Scholar
  • 6 Arora M, Dubin E. A clinical case study: sclerosing mesenteritis presenting as chylous ascites. Medscape J Med 2008; 10 (2) 30
    PubMedSearch in Google Scholar
  • 7 Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 1998; 9 (5) 727-734
    CrossrefPubMedSearch in Google Scholar
  • 8 Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 2010; 139 (3) 584-589 , discussion 589–590
    CrossrefPubMedSearch in Google Scholar
  • 9 Davidson JW. Lipid embolism to the brain following lymphography. Case report and experimental study. Am J Roentgenol Radium Ther Nucl Med 1969; 105 (4) 763-771
    CrossrefPubMedSearch in Google Scholar
  • 10 Moskowitz G, Chen P, Adams DF. Lipid embolization to the kidney and brain after lymphangiography. Radiology 1972; 102 (2) 327-328
    CrossrefPubMedSearch in Google Scholar
  • 11 Nelson B, Rush EA, Takasugi M, Wittenberg J. Lipid embolism to the brain after lymphography. N Engl J Med 1965; 273 (21) 1132-1134
    CrossrefPubMedSearch in Google Scholar
  • 12 Winterer JT, Blum U, Boos S, Konstantinides S, Langer M. Cerebral and renal embolization after lymphography in a patient with non-Hodgkin lymphoma: case report. Radiology 1999; 210 (2) 381-383
    CrossrefPubMedSearch in Google Scholar
  • 13 Kusumoto S, Imamura A, Watanabe K. Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings. Clin Radiol 1991; 44 (4) 279-280
    CrossrefPubMedSearch in Google Scholar
  • 14 de Munck B, Bourgeois P, Vanderperre H, Vermeulen J, Clarysse HJ, Demeester J. [Fatty cerebral embolism after lymphography]. Rev Neurol (Paris) 1988; 144 (2) 127-130
    PubMedSearch in Google Scholar
  • 15 Sane DC, Massey EW, Moore J. Lipid cerebral embolization following lymphogram. Clin Neuropharmacol 1985; 8 (2) 184-188
    CrossrefPubMedSearch in Google Scholar
  • 16 Cammermeyer J, Swank RL. Acute cerebral changes in experimental canine fat embolism. Exp Neurol 1959; 1: 214-232
    CrossrefPubMedSearch in Google Scholar
  • 17 Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest 2013; 144 (3) 1033-1044
    CrossrefPubMedSearch in Google Scholar
  • 18 Kopetz S, Jimenez C, Tu S-M, Sharma P. Pulmonary arteriovenous fistula in a patient with renal cell carcinoma. Eur Respir J 2007; 29 (4) 813-815
    CrossrefPubMedSearch in Google Scholar
  • 19 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
    CrossrefPubMedSearch in Google Scholar
  • 20 Charawanamuttu AM, Hughes-Nurse J, Hamlett JD. Retinal embolism after hysterosalpingography. Br J Ophthalmol 1973; 57 (3) 166-169
    CrossrefPubMedSearch in Google Scholar
  • 21 Choi C-S, Kim KH, Seo GS , et al. Cerebral and pulmonary embolisms after transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 2008; 14 (30) 4834-4837
    CrossrefPubMedSearch in Google Scholar
  • 22 Uzun O, Findik S, Danaci M, Katar D, Erkan L. Pulmonary and cerebral oil embolism after hysterosalpingography with oil soluble contrast medium. Respirology 2004; 9 (1) 134-136
    CrossrefPubMedSearch in Google Scholar
  • 23 Chung JW, Park JH, Im JG, Han JK, Han MC. Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 1993; 187 (3) 689-693
    CrossrefPubMedSearch in Google Scholar
  • 24 Gough MH. Lymphangiography in children. Arch Dis Child 1964; 39: 177-181
    CrossrefPubMedSearch in Google Scholar
  • 25 Fyfe NC, Rutt DL, Edwards JM, Kinmonth JB. Intralymphatic steroid therapy for lymphoedema: preliminary studies. Lymphology 1982; 15 (1) 13-28
    PubMedSearch in Google Scholar
  • 26 Koehler PR, Meyers WA, Skelley JF, Schaffer B. Body distribution of ethiodol following lymphangiography. Radiology 1964; 82: 866-871
    CrossrefPubMedSearch in Google Scholar