[Fatty cerebral embolism after lymphography]

A 25 year-old man with Hodgkin's disease, presented a confusional state with choreatic movements, 1 hour after a lymphography. CT showed high density in the heads of both caudate nuclei, and in the cortex. The patient's state improved and he entirely recovered within 2 weeks, while CT returned to normal. No right-to-left shunt was demonstrated. The mechanisms of this infrequent complication of lymphography are discussed: exceeding filtration capacity of lung because of a too rapid administration of contrast or severe lung embolism? intracardiac right-to-left shunts? microscopic arteriovenous shunts in the lung? bad venous cerebral drainage consecutive to a vena cava superior syndrome?