Long-Term Multifocal Pulmonary Fibrosis Associated with Y-90 Embolization: A Case Report and Literature Review

Area of Science:

• Interventional Radiology
• Pulmonary Medicine
• Oncology

Background:

• Radioembolization with Yttrium-90 (Y-90) beads is a standard treatment for liver tumors.
• Hepatopulmonary shunting of Y-90 beads can cause short-term radiation pneumonitis.
• Long-term pulmonary complications following Y-90 radioembolization are not well-documented.

Purpose of the Study:

• To report a case of multifocal interstitial pulmonary fibrosis after Y-90 radioembolization.
• To identify radiation fibrosis as a potential long-term complication of Y-90 treatment.
• To emphasize the importance of considering radiation fibrosis in post-radioembolization patients with lung abnormalities.

Main Methods:

• A case report detailing a patient treated with Y-90 radioembolization for hepatocellular carcinoma.
• Chest CT scans were used to monitor pulmonary changes post-procedure.
• Pathological examination confirmed multifocal fibrosis associated with Y-90 beads.

Main Results:

• The patient developed multifocal interstitial pulmonary fibrosis seven months after Y-90 radioembolization.
• Pulmonary opacities progressed and consolidated over 75 months.
• Fibrosis was confirmed pathologically, despite a low shunting fraction and absence of clinical pneumonitis.

Conclusions:

• Radiation-induced pulmonary fibrosis is a potential long-term complication of Y-90 radioembolization.
• This finding is significant even in the absence of significant hepatopulmonary shunting or acute radiation pneumonitis.
• Radiation fibrosis should be considered in the differential diagnosis of unexplained reticular opacities in patients post-Y-90 radioembolization.