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The CT appearances of hepatic oil embolism following lymphography

E. J. Silverstone, M.B., M.R.C.P. ^* R. M. Blaquiere, B.Sc., M.B., F.R.C.R. and J. S. Macdonald, F.R.C.P.E., F.R.C.R.

Cancer Research Campaign CT Scanning Unit and Diagnostic X-Ray Department, Royal Marsden Hospital, Sutton, Surrey

Four instances of lymphography complicated by hepatic oil embolism are presented. The subsequent computerised tomography appearances can be misleading: the oily contrast medium mimics hepatic calcification and this may be mistakenly thought to indicate calcified hepatic metastases. The correct diagnosis will become apparent if a history of lymphography is sought, and it is important to realise that, even on conventional radiography, hepatic oily contrast medium may remain visible for several months. Computerised tomography is a much more sensitive indicator of the presence of oily contrast medium in the liver, so the absence of detectable oil on conventional radiography is unhelpful. The mechanisms which are thought to lead to hepatic oil embolism are discussed because recognition of the circumstances leading to hepatic oil embolism and appreciation of the associated findings will provide further clues to the correct diagnosis.

^* Present Address: St. George's Hospital, Tooting, London SW17

Present Address: Southampton General Hospital, Southampton

Received for publication October 1, 1983. Revision received March 1, 1984.