TREATMENT OF THROIUM DIOXIDE GRANULOMAS OF THE NECK
The incidence of malignancy following the use of ThO/sub 2/ as a contrast medium (Thorotrast) is discussed and the case history of a patient developing a cervical granuloma 20 yr after its use for arteriography is presented. Such granulomatous formations have been observed to accompany accidental extravascular injections of the compound into the groin, antecubital fossa and neck. In these areas cells injured or destroyed by alpha activity provoke an intense connective-tissue response. The result is a painful, enlarging fibrous mass, which eventually leads to contracture and limitation of function. Although total excision of an accessible lesion of an extremity is generally successful, surgical treatment of the cervical tumors has been discouraging. Since the effects of radiation injury are cumulative, the possibility of further tissue damage from small deposits beyond the limits of resection was considered remote within the lifetime of the patient. A brief review is presented of the symptoms and treatment of 45 patients with cervical perivascular deposits of ThO/sub 2/ and symptomatic granulomas reported in the English literature. From these reports it is evident that both the supporting and specialized soft tissues of the neck are susceptible to chronic radiation injury. The radiation-induced pharyngoesophageal lesions include indolent ulcers, fistula formation, and stenosis. Necrosis of the epithelium, together with an impaired blood supply and cicatricial reaction, account for these changes. The combined effect of endothelial damage from ionizing radiation and vascular constriction from the enveloping mass fibrosis also lead to gradual thrombosis and occlusion. (BBB)
- Research Organization:
- Downstate Medical Center, Brooklyn
- Sponsoring Organization:
- USDOE
- NSA Number:
- NSA-17-035543
- OSTI ID:
- 4657745
- Journal Information:
- New Engl. J. Med., Journal Name: New Engl. J. Med. Vol. Vol: 268
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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