A 47 - year - old woman was admitted to our department after surgical resection for ACC. She was alert and conscious. According to the medical history, the patient underwent high-resolution computed tomography (CT) of the chest, abdomen, and pelvis in May 2019, which indicated a large space occupying right adrenal gland with local necrosis (Fig. 1). The patient underwent right adrenal resection, and was defined as ACC in combination with immunohistochemical parameters and postoperative pathology [5]. Tumor cells were detected in the vena cava, and mitotane was taken all the time after surgery for ACC. On admission, the patient presented hypertension with blood pressure fluctuation of 169 − 139/101 − 90 mmHg, heart rate of 60–70 beats/min, no liver and kidney function impairment, and blood oxygen saturation of 98%, the hormone level: ACTH 36.4 pg/ml, cortisol 14.69 µg/dL. High-resolution computed tomography (CT) scans of the chest, abdomen and pelvis showed changes in adrenal resection, but the left lobe of the liver was a large circular mass, about 112.7*79.8 mm in size, with irregular density. This indicates that ACC recurrence is accompanied by liver metastasis, which is also one of the most common metastatic sites of ACC [6]. According to the Clinical Practice guidelines of the European Endocrine Society for the treatment of adult adrenal cortical carcinoma, local treatment may be beneficial for patients with advanced ACC with metastasis. We treated her with trans-catheter arterial chemo-embolization(TACE)for liver lesions. We choose to puncture the right femoral artery, and the 5F catheter sheath and the 5F RH catheter were inserted successively. The catheter head was inserted into the celiac artery for DSA imaging. A lightly stained large tumor was seen in the left lobe of the liver, and the left hepatic artery participated in the blood supply of the tumor. A microcatheter was used to superselect into the blood supply artery of the left hepatic artery tumor, and the mixed emulsion of 60 mg cisplatin + 10 ml iodized oil was injected, and an appropriate amount of 560 µm gelatin sponge particles were used to reinforce the embolism. The second imaging showed that the lipiodol deposition was acceptable and the blood supply artery of the tumor was blocked (Fig. 2). After the operation, anti-infection, liver protection, hemostasis, fluid infusion and other symptomatic treatment. In the first three days after the operation, the patient was accompanied by fever, mild liver damage, and blood pressure maintained at 104 − 100/70 − 60 mmHg. The treatment was treated with anti-infection, liver protection, and fluid infusion. On the 4th day, the patient’s fatigue, anorexia, fever, morning blood pressure decreased to 77/41 mmHg, heart rate 80 beats/min, hemoglobin 105 g/dL, K 2.56 mmol/L, Na 123.8 mmol/L, C-reactive protein 219.80 µg/L, fever to 39.2℃, We suspect that there may be Embolism syndrome. Hemostasis, dopamine raises blood pressure, electrolyte balance correction, and fluid infusion were treated. Afterwards, blood pressure remained at about 105/90 mmHg, but the patient's condition has not improved significantly. Re-check the hormone level: ACTH 298.54 pg/ml, cortisol < 0.1 µg/dl. We believe that it is caused by decreased adrenal cortex function, but due to the possible risk of bleeding, we only give hydrocortisone 100 mg every other day and maintain dopamine boost. After that, the patient's condition was stabilized, the blood pressure maintained at 136 − 120/95 − 82 mmHg, and the reexamination of CT showed that the lipiodol was deposited well and was discharged from the hospital (Fig. 3).