Radiology, Vol 161, 439-442, Copyright © 1986 by Radiological Society of North America
Causes of jaundice during hepatic artery infusion chemotherapy
SD Anderson, HC Holley, LL Berland, JA Van Dyke and RJ Stanley
Jaundice develops in many patients with liver metastases from colorectal
adenocarcinoma during hepatic arterial infusion chemotherapy (HAIC). The
usual cause is thought to be hepatotoxicity from the chemotherapeutic agent
or biliary obstruction from progressive neoplastic disease. The authors
evaluated the abdominal computed tomography and ultrasound examinations
performed on 49 patients who were jaundiced during long-term HAIC. In only
one patient was diffuse intrahepatic biliary dilatation caused by an
obstructing mass in the porta. Two patients had metastatic hepatic lesions
causing focal biliary obstruction. Intrahepatic dilatation without an
obstructing mass occurred in 20 patients. Percutaneous or endoscopic
cholangiograms were commonly interpreted prospectively as showing extrinsic
compression by metastases, but no mass was confirmed on imaging studies.
Seven patients had focal intrahepatic ductal dilatation from stricture
without an associated mass. The remaining 19 patients had normal-caliber
ducts; their jaundice was caused by chemical hepatitis. This series
suggests that the most common causes of jaundice in these patients are
chemical hepatitis and common bile duct stricture, complications of
intraarterial chemotherapy, rather than neoplastic obstruction. Stricture
formation may be confused with extrinsic compression on direct
cholangiograms.
