COLLOIDAL THORIUM DIOXIDE (THOROTRAST) IN RADIOLOGY WITH EMPHASIS ON HEPATIC CANCEROGENESIS

A CASE REPORT OF OCCLUDED CAROTID AND JUGULAR VESSELS WITH NERVE INJURIES AND A CASE OF HEPATOMA, 27 AND 33 YEARS AFTER ITS ADMINISTRATION

¹ Staff Radiologist, Minneapolis Veterans Hospital, Instructor, University of Minnesota Medical School, Minneapolis, Minnesota
² Staff Pathologist, Minneapolis Veterans Hospital, Instructor, University of Minnesota Medical School, Minneapolis, Minnesota
³ Research Chemist, Minneapolis Veterans Hospital, Research Associate, University of Minnesota Medical School, Minneapolis, Minnesota

Two cases of severe thorotrast reaction are reported. In I, a 60 year old male, extravasation of thorotrast had occurred into the carotid sheath 27 years previously at attempted carotid arteriography which resulted in obliteration of the right common carotid artery and internal jugular vein. The second case, a 53 year old male, developed a liver cell type of carcinoma (hepatoma) 33 years after the intravenous administration of thorotrast.

In the literature we found 65 cases of liver malignancies (including our Case II) which were reported in association with previous intravascular administration of thorotrast. Of this number, the majority (41) were sarcomas, principally hemangioendotheliomas. There were 24 carcinomas of which 8 were hepatomas, including our Case II, and II cholangiomas; 5 were not classified.³

The history, dosage, roentgenographic diagnosis, sequelae, and the present day use of this colloidal form of thorium dioxide are discussed.

Another factor in liver carcinogenesis was present in Case II; namely, chronic alcoholism. The high relationship of liver cell carcinomas with Laennec's cirrhosis is well accepted. However, one cannot state with certainty that in this case, the chronic use of alcohol added any additional cirrhotic changes to the already present severe cirrhosis due to alpha rays. The principal carcinogenic effect in this case is considered to be the extremely high absorbed dose of radiation; namely, 34,000 rems to the liver from the alpha particles.

In Case I, the severe granulomatous desmoplastic reaction from this long term alpha emitter did cause a complete obliteration of the right common carotid artery and of the internal jugular vein. There was also an associated right sided vocal cord paralysis, Horner's syndrome, and paresis of the ninth to twelfth cranial nerves.

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