Illustration of lipiodol accumulation in the lungs, a rare complication of TACE.

Pulmonary Lipiodol Accumulation: What to Know About This Rare TACE Complication

Lena Voss in Health & Wellness August 2025 • 4 min read.

"Understanding the causes, symptoms, and management of pulmonary lipiodol accumulation after transarterial chemoembolization."

Transarterial chemoembolization (TACE) is a crucial procedure in treating hepatocellular carcinoma (HCC), a common type of liver cancer. By delivering chemotherapy directly to the tumor site, TACE effectively blocks the tumor's blood supply, slowing its growth. This targeted approach minimizes damage to healthy tissues, improving patient outcomes. However, like any medical intervention, TACE isn't without potential complications. One such complication, though rare, is pulmonary lipiodol accumulation (PLA).

PLA occurs when lipiodol, an oily contrast agent used in TACE, unintentionally accumulates in the lungs. While TACE is designed to target tumors, the accidental perfusion of lipiodol into arteriovenous shunts or the inferior phrenic artery can lead to PLA. This accumulation can manifest in various ways, sometimes accompanied by intrathoracic abnormalities. Understanding the causes, symptoms, and management of PLA is essential for both healthcare professionals and patients undergoing TACE.

This article delves into the specifics of PLA, exploring its incidence, diagnosis, and radiologic outcomes following TACE. Drawing on clinical research, we aim to provide a comprehensive overview of this rare complication, offering insights into its management and potential impact on patient recovery.

What are the Symptoms and CT Findings of Pulmonary Lipiodol Accumulation?

Illustration of lipiodol accumulation in the lungs, a rare complication of TACE.

The symptoms and CT findings of pulmonary lipiodol accumulation (PLA) can vary, but it's essential to recognize the potential signs. While some patients may experience no noticeable symptoms, others might develop respiratory issues such as cough, fever, dyspnea (shortness of breath), or hemoptysis (coughing up blood). The severity of these symptoms can range from mild discomfort to more significant respiratory distress.

Computed tomography (CT) scans play a crucial role in diagnosing PLA. On CT images, lipiodol accumulation may appear as areas of increased density in the lungs. These accumulations can be located in different regions, including the right lower lobe, right middle lobe, and left lower lobe. Associated intrathoracic abnormalities, such as pleural effusion (fluid around the lungs) and consolidation (lung tissue becoming filled with fluid or inflammatory material), may also be visible on CT scans.

Asymptomatic Presentation: Some individuals may show no immediate symptoms, with the accumulation only detected through imaging.
Respiratory Symptoms: Potential symptoms include cough, shortness of breath, fever, and hemoptysis.
CT Scan Findings: Accumulations appear as dense areas, often in the lower lobes, potentially accompanied by pleural effusion or consolidation.

It's worth noting that high-attenuation linear branching opacities, which might indicate lipiodol casts in the pulmonary arteries, are not always present on non-enhanced CT scans. Therefore, a comprehensive evaluation, including clinical assessment and radiographic findings, is necessary for accurate diagnosis.

Prognosis and Treatment of Pulmonary Lipiodol Accumulation

The recovery time for lipiodol accumulation is approximately 66 days. The clinical and radiological outcome of PLA without respiratory failure is promising, and conservative treatment is sufficient when lipiodol accumulation is observed in CT images after TACE.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3348/jksr.2011.65.6.577, Alternate LINK

Title: Pulmonary Lipiodol Accumulation After Transarterial Chemoembolization: Ct Findings And Its Radiologic Outcomes

Subject: Radiology, Nuclear Medicine and imaging

Journal: Journal of the Korean Society of Radiology

Publisher: The Korean Society of Radiology

Authors: Inyoung Youn, Semin Chong, Byung Kook Kwak, Hyung Jin Shim, Gi Young Seo, Jae Seung Seo, Jae Kyun Kim

Published: 2011-01-01

Everything You Need To Know

What exactly is pulmonary lipiodol accumulation, and how does it happen during TACE?

Pulmonary lipiodol accumulation, or PLA, occurs when lipiodol, an oily contrast agent used during transarterial chemoembolization (TACE) for liver cancer, inadvertently accumulates in the lungs. While TACE aims to target tumors directly, sometimes lipiodol can enter arteriovenous shunts or the inferior phrenic artery, leading to PLA.

What are the symptoms and CT findings associated with pulmonary lipiodol accumulation?

Symptoms can range from no noticeable symptoms to respiratory issues such as cough, fever, dyspnea (shortness of breath), or hemoptysis (coughing up blood). The severity can vary greatly. Computed tomography (CT) scans are crucial for diagnosis, revealing dense areas in the lungs, often in the lower lobes, sometimes accompanied by pleural effusion (fluid around the lungs) or consolidation (lung tissue becoming filled with fluid or inflammatory material).

What is the typical prognosis and treatment approach for pulmonary lipiodol accumulation?

The recovery time for pulmonary lipiodol accumulation is approximately 66 days. Conservative treatment is generally sufficient for patients without respiratory failure when lipiodol accumulation is observed in CT images post-TACE. This means that the clinical and radiological outcome of PLA without respiratory failure is generally positive.

In the context of liver cancer treatment, what is transarterial chemoembolization (TACE), and how does it relate to pulmonary lipiodol accumulation?

Transarterial chemoembolization (TACE) is a procedure used to treat hepatocellular carcinoma (HCC), a type of liver cancer. It involves delivering chemotherapy directly to the tumor site, blocking the tumor's blood supply and slowing its growth. Lipiodol is an oily contrast agent used in TACE. Pulmonary lipiodol accumulation (PLA) is a rare complication of TACE where lipiodol accumulates in the lungs.

Why are high-attenuation linear branching opacities important to consider, and why aren't they always visible on CT scans when evaluating pulmonary lipiodol accumulation?

While high-attenuation linear branching opacities might indicate lipiodol casts in the pulmonary arteries, these are not always present on non-enhanced CT scans. A comprehensive evaluation, including clinical assessment and radiographic findings, is necessary for accurate diagnosis of pulmonary lipiodol accumulation. This highlights the importance of combining clinical observations with imaging results.