Case Report: Disseminated Systemic Embolism of Lipiodol After Lymphography for Plastic Bronchitis After Fontan Repair

Frontiers in Pediatrics
Jelena HubrechtsMarc Gewillig

Abstract

Lipiodol-based lymphangiography is not only a diagnostic tool for visualization of lymphatic disorders such as plastic bronchitis (PB), but also aims a therapeutic effect by embolizing lymph leakages. We performed such percutaneous lymphatic embolization for PB in a Fontan patient with proven absence of right-to-left shunt, and demonstrated important lymphatic abnormalities in the mediastinum. Shortly after the procedure, the patient developed severe convulsive seizures, revealing multiple cerebral embolisms of Lipiodol. Radiological images were impressive, yet the clinical neurological outcome was favorable. Lipiodol-based lymphography in Fontan patients with plastic bronchitis should be avoided as this subgroup is more likely to have developed lympho-pulmonary venous connections which allow systemic emboli.

References

Apr 19, 2011·Acta Radiologica·Enrique Alejandre-LafontGabriele A Krombach
Jul 17, 2012·Pediatric Cardiology·Regine L CaruthersKathleen A Stringer
Feb 11, 2015·The Journal of Pediatrics·Kurt R SchumacherMark W Russell
Jun 15, 2016·The Journal of Pediatrics·Matthew P KirschenArastoo Vossough
Apr 5, 2019·Circulation. Cardiovascular Imaging·Sheyanth MohanakumarVibeke Hjortdal
Oct 10, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Geert MaleuxMarc Gewillig
Dec 31, 2019·Paediatric Respiratory Reviews·David M BikoFernando Escobar
Apr 1, 2020·Journal of the American Heart Association·Reena M GhoshYoav Dori
Sep 30, 2020·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Jelena HubrechtsMarc Gewillig

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