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Skin Injuries from Fluoroscopically Guided Procedures

Part 1, Characteristics of Radiation Injury

¹ Department of Radiology, The University of Texas—Houston Medical School, 6431 Fannin St., Houston, TX 77030.
² Moerser Landstr. 352, D-47802 Krefeld, Germany.
³ Department of Radiology, University of New Mexico School of Medicine, 915 Camino de Salud, Albuquerque, NM 87131-5336.

View larger version (103K): [in a new window]   Fig. 1A. —49-year-old woman with 8-year history of refractory supraventricular tachycardia. (Reprinted with permission from [20]) Photographs show sharply demarcated erythema above right elbow at 3 weeks after radiofrequency cardiac catheter ablation (A), tissue necrosis 5 months after procedure (B), and deep ulceration with exposure of the humerus at 6.5 months (C).

View larger version (123K): [in a new window]   Fig. 2. —56-year-old man with obstructing lesion of right coronary artery. Photograph of right posterolateral chest wall at 10 weeks after percutaneous transluminal coronary angioplasty shows 12 x 6.5 cm hyperpigmented plaque with hyperkeratosis below right axilla (Table 2, patient 2).

View larger version (123K): [in a new window]   Fig. 3. —75-year-old woman with 90% stenosis of right coronary artery. Photograph of right lateral chest obtained 10 months after percutaneous transluminal coronary angioplasty shows area of hyper- and hypopigmentation, skin atrophy, and telangiectasia (poikiloderma) (Table 2, patient 5).

View larger version (151K): [in a new window]   Fig. 4. —48-year-old woman with history of diabetes mellitus and severe coronary artery disease who underwent two percutaneous transluminal coronary angioplasties and stent placements within a month. Photograph of left mid back 2 months after last procedure shows well-marginated focal erythema and desquamation. (Reprinted with permission from [11])

View larger version (127K): [in a new window]   Fig. 5. —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. (Reprinted with permission from [10])

View larger version (126K): [in a new window]   Fig. 1B. —49-year-old woman with 8-year history of refractory supraventricular tachycardia. (Reprinted with permission from [20]) Photographs show sharply demarcated erythema above right elbow at 3 weeks after radiofrequency cardiac catheter ablation (A), tissue necrosis 5 months after procedure (B), and deep ulceration with exposure of the humerus at 6.5 months (C).

View larger version (89K): [in a new window]   Fig. 1C. —49-year-old woman with 8-year history of refractory supraventricular tachycardia. (Reprinted with permission from [20]) Photographs show sharply demarcated erythema above right elbow at 3 weeks after radiofrequency cardiac catheter ablation (A), tissue necrosis 5 months after procedure (B), and deep ulceration with exposure of the humerus at 6.5 months (C).

View larger version (159K): [in a new window]   Fig. 6D. —49-year-old man with history of liver cirrhosis and intractable upper gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic shunt (TIPS) placements and one attempted TIPS placement within a week. Photographs show progression of ulceration (Table 2, patient 14). Nonhealing ulcer with exposure of deep tissues, including spinous process of vertebra, at 22 months.

View larger version (123K): [in a new window]   Fig. 6A. —49-year-old man with history of liver cirrhosis and intractable upper gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic shunt (TIPS) placements and one attempted TIPS placement within a week. Photographs show progression of ulceration (Table 2, patient 14). Secondary ulceration with surrounding rings of de- and hyperpigmentation 6 months later.

View larger version (137K): [in a new window]   Fig. 6B. —49-year-old man with history of liver cirrhosis and intractable upper gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic shunt (TIPS) placements and one attempted TIPS placement within a week. Photographs show progression of ulceration (Table 2, patient 14). Small blisters developed at 7.5 months after procedure. Wound is very painful.

View larger version (121K): [in a new window]   Fig. 6C. —49-year-old man with history of liver cirrhosis and intractable upper gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic shunt (TIPS) placements and one attempted TIPS placement within a week. Photographs show progression of ulceration (Table 2, patient 14). Wound has progressed in size and depth at 10 months.

View larger version (143K): [in a new window]   Fig. 6E. —49-year-old man with history of liver cirrhosis and intractable upper gastrointestinal bleeding who underwent two transjugular intrahepatic portosystemic shunt (TIPS) placements and one attempted TIPS placement within a week. Photographs show progression of ulceration (Table 2, patient 14). At 23 months, musculocutaneous skin grafting was performed. Disfigurement is permanent.

View larger version (142K): [in a new window]   Fig. 7. —54-year-old man with stenosis of left circumflex artery. Photograph of right shoulder at 5.5 months after percutaneous transluminal coronary angioplasty shows area of depigmentation and atrophy (Table 2, patient 1). Injury progressed to deep ulceration, requiring skin grafting.

View larger version (157K): [in a new window]   Fig. 8. —17-year-old girl with history of cardiac arrhythmia underwent two cardiac ablation procedures in 13 months. Photograph taken 2 years after last intervention shows atrophic indurated plaque with skin telangiectasia at right lateral chest wall involving posterolateral aspect of breast. Induration resulted in limited movement of right arm. Risk of breast cancer is increased. (Reprinted with permission from [19])

View larger version (163K): [in a new window]   Fig. 9. —69-year-old man with history of angina who underwent three coronary angiograms followed by three angioplasties within 8 months. Photograph 3 years after last procedure shows skin necrosis with surrounding erythema and hyperpigmentation in right subscapular region. (Reprinted with permission from [12])

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