A Cerebral Ethiodized Embolism after Lymphangiography: A Case Report and Literature Review.
Jun Sawada, Hidetaka Iwamoto, Shunta Ishitoya et al.
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Case in brief
A patient with hilar cholangiocarcinoma underwent ultrasound-guided intranodal lymphangiography for refractory chylothorax and chylous ascites. After the procedure, the patient developed impaired consciousness and convulsions. Brain CT and MRI showed diffuse ethiodized-oil microdroplet emboli involving both cerebral cortices, the basal ganglia, thalami, and cerebellum. The report identifies cerebral ethiodized oil embolism as the explanation for the post-procedural neurological presentation.
What made this case unusual
The emboli were diffuse, involving multiple bilateral brain regions, including the cortex, deep nuclei, thalami, and cerebellum, after lymphangiography.
Diagnostic / clinical pearl
After lymphangiography, new impaired consciousness or convulsions should prompt consideration of cerebral ethiodized oil embolism; brain CT and MRI can demonstrate the embolic droplets.