[Chronic radiodermatitis after interventional cardiac catheterization. Four cases].

BACKGROUND

Fluoroscopic and cineradiographic procedures expose patients undergoing coronarography to high doses of ionizing irradiation.

CASE REPORT

We report four cases of radiodermitis following cardiac catheterization. A 69-year-old man developed a radio-induced ulceration on the left scapular region in 1991 which required excision with skin graft. He had undergone 3 coronarographies and 2 angioplasties from 1989 to 1991. In 1992, a 59-year-old women developed a hard dorsal lesion with central ulceration and scar formation requiring excision and graft. From 1990 to 1992, she had undergone two coronary dilatations with angioplasty during one procedure. An atrophic necrotic wound situated under the right nipple developed in a 63 year old man. Excision with flap reconstruction was performed in 1993, two years after an unsuccessful angioplasty then two-vessel bypass. In a fourth case, a 52 year-old woman developed a telangiectasic ulceration on the right breast in 1990. The diagnosis of radio-induced dermitis was confirmed in 1996 and the patient was treated by excision. She had had three angioplasties in 1989.

DISCUSSION

Four other cases of radio-induced dermatitis following cardiac catheterism have been reported in the literature since 1996. Six other cases were also recently reported in France. All of these patients had undergone coronarography with transluminal coronary angioplasty. Besides coronarography, irradiation exposure is greatest for guide and balloon insertion required for dilatation procedures. Angioplasty is particularly dangerous because the irradiation beam is focused on the stenosis while the entire coronary network is concerned for coronarography. In most cases of radio-induced dermatitis following cardiac catheterism, the diagnosis is usually evident from the clinical context and the localization of the coronary lesion. In many cases however, the long delay to onset may make diagnosis a difficult task. In addition, the radiation dose delivered to the skin during cardiac procedures is not measured.