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Diaphragmatic Weakness after Transcatheter Arterial Chemoembolization of Inferior Phrenic Artery for Treatment of Hepatocellular Carcinoma¹

¹ From the Department of Radiology and Center for Imaging Sciences (S.W.S., Y.S.D., S.W.C., W.C.L., S.K.C., K.B.P., I.W.C.), Division of Gastroenterology (B.C.Y.), and Department of Medicine, Division of Pulmonary and Critical Care Medicine (E.H.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea. Received July 19, 2005; revision requested September 22; revision received October 19; accepted November 17; final version accepted January 2, 2006. Address correspondence to Y.S.D. (e-mail: ysdo{at}smc.samsung.co.kr).

View larger version (108K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Images in 59-year-old man with HCC. (a) Transverse arterial phase CT image shows peripheral area of tumor (arrows), with no iodized oil retention within the liver segment VIII abutting the diaphragm. (b) Posteroanterior selective arteriogram of the right IPA. This portion of the tumor (arrows) was noted to be supplied by the right IPA. (c) Transverse arterial phase CT image obtained 3 months after TACE of the IPA shows compact retention (arrows) of iodized oil within the tumor.

View larger version (150K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Images in 59-year-old man with HCC. (a) Transverse arterial phase CT image shows peripheral area of tumor (arrows), with no iodized oil retention within the liver segment VIII abutting the diaphragm. (b) Posteroanterior selective arteriogram of the right IPA. This portion of the tumor (arrows) was noted to be supplied by the right IPA. (c) Transverse arterial phase CT image obtained 3 months after TACE of the IPA shows compact retention (arrows) of iodized oil within the tumor.

View larger version (141K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Images in 59-year-old man with HCC. (a) Transverse arterial phase CT image shows peripheral area of tumor (arrows), with no iodized oil retention within the liver segment VIII abutting the diaphragm. (b) Posteroanterior selective arteriogram of the right IPA. This portion of the tumor (arrows) was noted to be supplied by the right IPA. (c) Transverse arterial phase CT image obtained 3 months after TACE of the IPA shows compact retention (arrows) of iodized oil within the tumor.

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Images in 52-year-old man with HCC. (a) Posteroanterior chest radiograph obtained before TACE of the right IPA shows no abnormality. (b) Posteroanterior chest radiograph obtained 2 months after TACE shows elevation of the right hemidiaphragm and compensatory hyperinflation of the left lung, along with linear atelectasis in the right lung base. (c) Expiratory and (d) inspiratory supine posteroanterior fluoroscopic images obtained 2 months after TACE of the IPA show markedly decreased movement of the right hemidiaphragm.

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Images in 52-year-old man with HCC. (a) Posteroanterior chest radiograph obtained before TACE of the right IPA shows no abnormality. (b) Posteroanterior chest radiograph obtained 2 months after TACE shows elevation of the right hemidiaphragm and compensatory hyperinflation of the left lung, along with linear atelectasis in the right lung base. (c) Expiratory and (d) inspiratory supine posteroanterior fluoroscopic images obtained 2 months after TACE of the IPA show markedly decreased movement of the right hemidiaphragm.

View larger version (125K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Images in 52-year-old man with HCC. (a) Posteroanterior chest radiograph obtained before TACE of the right IPA shows no abnormality. (b) Posteroanterior chest radiograph obtained 2 months after TACE shows elevation of the right hemidiaphragm and compensatory hyperinflation of the left lung, along with linear atelectasis in the right lung base. (c) Expiratory and (d) inspiratory supine posteroanterior fluoroscopic images obtained 2 months after TACE of the IPA show markedly decreased movement of the right hemidiaphragm.

View larger version (126K): [in this window] [in a new window] [Download PPT slide]   Figure 2d: Images in 52-year-old man with HCC. (a) Posteroanterior chest radiograph obtained before TACE of the right IPA shows no abnormality. (b) Posteroanterior chest radiograph obtained 2 months after TACE shows elevation of the right hemidiaphragm and compensatory hyperinflation of the left lung, along with linear atelectasis in the right lung base. (c) Expiratory and (d) inspiratory supine posteroanterior fluoroscopic images obtained 2 months after TACE of the IPA show markedly decreased movement of the right hemidiaphragm.

View larger version (133K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Transverse portal venous phase CT images in 60-year-old man with HCC obtained (a, b) before and (c, d) after TACE of the IPA. (a, b) Scans obtained at the level of the celiac trunk (a) and the superior mesenteric artery (b) show thick appearance (arrowheads) of the crural portion of the right hemidiaphragm. (c, d) Scans obtained at the level of the celiac trunk (c) and the superior mesenteric artery (d) 2 months after TACE of the IPA show diffuse thinning (arrowheads) of the right hemidiaphragm. The scanned levels appear somewhat different from those on the pre-TACE CT scans owing to the elevation of the right diaphragm and compensatory overinflation of the left diaphragm. The crural portion of the left hemidiaphragm shows no definite change.

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Transverse portal venous phase CT images in 60-year-old man with HCC obtained (a, b) before and (c, d) after TACE of the IPA. (a, b) Scans obtained at the level of the celiac trunk (a) and the superior mesenteric artery (b) show thick appearance (arrowheads) of the crural portion of the right hemidiaphragm. (c, d) Scans obtained at the level of the celiac trunk (c) and the superior mesenteric artery (d) 2 months after TACE of the IPA show diffuse thinning (arrowheads) of the right hemidiaphragm. The scanned levels appear somewhat different from those on the pre-TACE CT scans owing to the elevation of the right diaphragm and compensatory overinflation of the left diaphragm. The crural portion of the left hemidiaphragm shows no definite change.

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Transverse portal venous phase CT images in 60-year-old man with HCC obtained (a, b) before and (c, d) after TACE of the IPA. (a, b) Scans obtained at the level of the celiac trunk (a) and the superior mesenteric artery (b) show thick appearance (arrowheads) of the crural portion of the right hemidiaphragm. (c, d) Scans obtained at the level of the celiac trunk (c) and the superior mesenteric artery (d) 2 months after TACE of the IPA show diffuse thinning (arrowheads) of the right hemidiaphragm. The scanned levels appear somewhat different from those on the pre-TACE CT scans owing to the elevation of the right diaphragm and compensatory overinflation of the left diaphragm. The crural portion of the left hemidiaphragm shows no definite change.

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: Transverse portal venous phase CT images in 60-year-old man with HCC obtained (a, b) before and (c, d) after TACE of the IPA. (a, b) Scans obtained at the level of the celiac trunk (a) and the superior mesenteric artery (b) show thick appearance (arrowheads) of the crural portion of the right hemidiaphragm. (c, d) Scans obtained at the level of the celiac trunk (c) and the superior mesenteric artery (d) 2 months after TACE of the IPA show diffuse thinning (arrowheads) of the right hemidiaphragm. The scanned levels appear somewhat different from those on the pre-TACE CT scans owing to the elevation of the right diaphragm and compensatory overinflation of the left diaphragm. The crural portion of the left hemidiaphragm shows no definite change.