Post-embolization syndrome

Post-embolisation syndrome (PES) is one of the commonestmost common side effects of transarterial embolisationembolization and chemoembolisationchemoembolization. It comprises of a constellation of fever, nausea/vomiting, and pain. It is often a self limiting-limiting phenomenon and usually occurs within the first 72 hours after embolisationembolization (liver lesion or uterine fibroids) and then starts to subside after 72 hours ¹. The etiology of PES is not fully established however it is postulated that tissue hypoxia and cell death lead to the release of tissue breakdown products, inflammatory mediators, and vasoactive substances from the tumor and or adjacent normal tissues.

It is not to be mistaken for a predictor of impending infection. Hence performing blood cultures in the absence of other factors is unnecessary ¹.  Preliminary evidence suggests that there may be an associated clinically significant leukocytosis in approximately 20% of patients with PES within the first 24 hours ⁴. It is therefore important to differentiate PES from infection and tumor lysis syndrome which require alternative management.

This condition is more often associated with large fibroids or large tumouror solid organ embolisation. 

Radiographic features

Early imaging following embolisation, either by ultrasound or CT, may reveal intralesional gas. This is not to be mistaken for abscess without additional factors ³.

Treatment and prognosis

Treatment is symptomatic relief; analgesia, IV fluids and TLC from a caring nursing ¹. It is normally self-limited ². Prophylactic use of antipyretic and antiemetic therapy may be considered prior to embolisation of large tumours/ fibroids.