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Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis
Matthew P Kirschen1, Yoav Dori2, Maxim Itkin3
1Department of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Plastic bronchitis patients undergoing lymphatic procedures with lipiodol contrast may experience altered mental status. This is due to cerebral lipiodol embolization from lymphatic-pulmonary vein shunts, a potential neurologic complication.
Area of Science:
- Cardiology
- Neurology
- Lymphatic Imaging
Background:
- Congenital heart disease can lead to plastic bronchitis.
- Interventional lymphatic procedures are used to manage lymphatic disorders.
- Lipiodol contrast is utilized in these procedures.
Observation:
- An adolescent patient with plastic bronchitis presented with altered mental status post-procedure.
- Neuroimaging identified lipiodol contrast within the cerebral vasculature.
Findings:
- The lipiodol emboli originated from direct shunting between lymphatic channels and pulmonary veins.
- This indicates a direct pathway for contrast material to reach the brain.
Implications:
- Cerebral lipiodol embolization is a significant neurologic risk associated with interventional lymphatic procedures.
- This finding necessitates careful patient selection and procedural monitoring.
- Further research into safer contrast agents or alternative procedures is warranted.
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