Hepatic radioembolization complicated by radiation cholecystitis

Biliary complications following yttrium-90 (⁹⁰Y) radioembolization are rare, and radiation-induced cholecystitis requiring intervention represents an even smaller proportion of these complications, reportedly occurring in fewer than 1% of patients treated with ⁹⁰Y [1]. However, its implications are serious, as the treatment of radiation cholecystitis may require cholecystectomy in patients otherwise considered poor surgical candidates. While biliary complications such as intrahepatic biliary strictures or bilomas may be unavoidable in the course of treating hepatic malignancies due to local field effects of radiation, radiation cholecystitis results from non-target embolization of radioactive microspheres. Meticulous attention to anatomic detail and catheter position may be adequate in preventing this avoidable complication. Herein we discuss the clinical, radiographic, and pathologic findings, as well as the outcome, of a patient who experienced radiation cholecystitis following ⁹⁰Y radioembolization.