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Skin Injuries from Fluoroscopically Guided Procedures

Part 2, Review of 73 Cases and Recommendations for Minimizing Dose Delivered to Patient

¹ Department of Radiology, The University of Texas-Houston Medical School, 6431 Fannin St., Houston, TX 77030.
² Department of Radiology, University of New Mexico School of Medicine, 915 Camino de Salud, Albuquerque, NM 87131-5336.

View larger version (132K): [in a new window]   Fig. 1. —17-year-old girl with history of cardiac arrhythmia who underwent two cardiac ablation procedures within 13 months. Photograph taken 2 years after last intervention shows atrophic indurated plaque at right lateral chest wall involving posterolateral aspect of right breast. Induration resulted in limited movement of her right arm. Long-term risk of breast cancer is increased. (Reprinted with permission from [20])

View larger version (154K): [in a new window]   Fig. 2A. —57-year-old man with coronary artery disease involving left circumflex artery who underwent several percutaneous transluminal coronary angioplasties with stent placements and rotational atherectomy that used 172 min of fluoroscopy. Five months later, similar procedure was performed for left anterior descending artery, involving 73 min of fluoroscopy and more than 2000 frames of cine. Both procedures were performed in steep beam angulation (Table 1, patient 8). Photograph 1 year after last procedure shows ulcer formation below right scapula (possibly a result of biopsy). Lower lesion (erythema) seen at right mid back resulted from second intervention. At time of second intervention, cause of first erythematous lesion was not recognized.

View larger version (145K): [in a new window]   Fig. 2B. —57-year-old man with coronary artery disease involving left circumflex artery who underwent several percutaneous transluminal coronary angioplasties with stent placements and rotational atherectomy that used 172 min of fluoroscopy. Five months later, similar procedure was performed for left anterior descending artery, involving 73 min of fluoroscopy and more than 2000 frames of cine. Both procedures were performed in steep beam angulation (Table 1, patient 8). Photograph taken 2 years after last procedure. Lesion was very painful throughout its course and required skin grafting.

View larger version (148K): [in a new window]   Fig. 3. —62-year-old man weighing 160 kg (350 lb) with history of angina, congestive heart failure, and diabetes mellitus (type II). Patient underwent coronary angioplasty and stent placement of left anterior descending artery and ostium of left coronary artery. Fluoroscopy time was recorded at 50 min during 2.5-hr procedure. Photograph approximately 7 months later shows full-thickness radiation injury measuring 15 cm (6 inches) in diameter on patient's mid back. Patient underwent skin grafting 8 months after procedure. Because of partial failure of first graft, lesion was regrafted 1 month later (Table 1, patient 11).

View larger version (136K): [in a new window]   Fig. 4A. —69-year-old man with history of angina who underwent two angioplasties of left coronary artery within 30 hr. Photograph taken 1-2 months after last procedure shows secondary ulceration over left scapula in area where two radiographic fields overlap. (Reprinted with permission from [11])

View larger version (48K): [in a new window]   Fig. 4B. —69-year-old man with history of angina who underwent two angioplasties of left coronary artery within 30 hr. Diagram shows region of overlap of two fields. Curved outline of fields results from projection of rectangular X-ray field onto curved surface of patient's back.

View larger version (141K): [in a new window]   Fig. 5. —69-year-old man with coronary artery disease involving left anterior descending and right coronary arteries. Two percutaneous transluminal coronary angioplasties and one diagnostic angiography examination were performed with 100 min of fluoroscopy at highest magnification. Patient developed pronounced erythema at 3 weeks that progressed to moist skin desquamation. Area of deep ulceration was present at 3 months. Photograph shows lesion that did not heal over course of 17 months. Elliptic shape of lesion is caused by two sequential procedures that used nearly the same tube position (Table 1, patient 9).

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