Clinical Characteristics and Outcomes of Acute Lung InjuryCaused by Transcatheter Arterial Chemoembolization forHepatocellular Carcinoma: A Retrospective Cohort Study from aSingle Institution in China

Background.Acute lung injury (ALI) is a rare but life-threatening pulmonary complication of transcatheter arterialchemoembolization (TACE) for hepatocellular carcinoma (HCC). The aim of this study was to characterize the common riskfactors, clinical features, imagingfindings, treatments, and outcomes of acute lung injury caused by TACE.Methods.Aretrospective study was performed on all TACE-associated ALI cases that were diagnosed at authors’hospital from January 2015to June 2018.Results. The study included 14 ALI cases where the mean age of patients was60:9±11:7years (range 41-82 years),with a mean onset time of2:4±1:6d after TACE. Of the 14 patients, 8 patients (57.1%) developed acute respiratory distresssyndrome (ARDS). 7 patients (50%) had underlying chronic respiratory disease and hepatic arteriovenousfistula was detected in6 patients (42.6%), both of which were significantly higher than control group (P<0:05). Dyspnea (92.9%) was the mostcommon symptoms. Pleural effusion (64.3%), diffuse pulmonary infiltration (42.9%), and accumulation of Lipiodol in lungfield(42.9%) were frequent radiologic abnormalities. 11 patients (78.6%) achieved remission after treatment, and the 30-daymortality rate was approximately 21.4%. Patient’s median survival time after the development of ALI was merely 4.3 months,which was obviously worse than control group (4.3 months vs. 13.5 months,P<0:05).Conclusion. This study illustrates thatTACE-associated ALI is a rare pulmonary complication with a high mortality rate. We infer that pulmonary Lipiodolembolization might be one of the main causes of TACE-associated ALI. Thus, HCC patients who are at high risk should beclosely evaluated and monitored during TACE to avoid such potentially fatal complication.