Radiation injury case study one

Radiation injury Microchapters
Home
Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Radiation injury from other Diseases
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Radiation injury case study one On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Radiation injury case study one All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Radiation injury case study one
CDC on Radiation injury case study one
Radiation injury case study one in the news
Blogs on Radiation injury case study one
Directions to Hospitals Treating Radiation injury
Risk calculators and risk factors for Radiation injury case study one

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Case #1

Clinical Summary

This 60-year-old white female had developed retraction of her left nipple six years earlier, at which time breast carcinoma was found. A radical mastectomy was performed. Examination of the surgical specimens showed metastases in regional lymph nodes and local irradiation was thus administered.

Two years later, carcinoma of the right breast was found. Following a modified mastectomy, more irradiation was given. A year later the patient developed recurrences for which chemotherapy (cytoxan and adriamycin) was given. After a two year period without problems, the patient developed decreased exercise tolerance, dyspnea on exertion, shortness of breath, paroxysmal nocturnal dyspnea, and orthopnea increasing in severity over 10 days. Chest examination revealed decreased breath sounds with dullness over the left base. Chest x-ray showed a globose cardiac silhouette and left pleural effusion.

A pericardiectomy was done because of suspected cardiac tamponade; however, the patient died soon after the operation.

Autopsy Findings

There was metastatic carcinoma in the pericardium, chest wall, diaphragm, both lungs, and mediastinal lymph nodes. Severe nonobstructive cardiomyopathy, probably secondary to adriamycin, was found. Areas of pleural thickening with adhesions and interstitial fibrosis were found involving the anterior aspect of both lungs.

Histopathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

This is a gross photograph of lung demonstrating areas of fibrosis on the pleural surface (arrow).

This is a gross photograph of cut sections of lung. There are several areas of fibrosis (arrows) within the lung parenchyma.

This is a gross photograph showing a closer view of a cut section of lung. An area of fibrosis (arrow) is evident in this photograph.

This is a low-power photomicrograph of lung section. Note the thickening of the alveolar septa (arrows).

This is a higher-power photomicrograph of lung section. Note the thickening of the alveolar septa (1) and accumulations of anthracotic pigment (2).

This is another high-power photomicrograph of lung section showing the thickening of the alveolar septa (arrows) and accumulations of black anthracotic pigment.

This high-power photomicrograph of lung section shows the thickening of the alveolar septum (arrows) by fibrous connective tissue.

This is a photomicrograph of a trichrome-stained section of lung demonstrating the extensive fibrosis throughout this section (green-blue stained material is fibrous connective tissue).

This is a photomicrograph of an area of tissue exhibiting diffuse fibrosis and thickening of the alveolar septa.

This is another high-power photomicrograph of an area of tissue with diffuse fibrosis and thickening of the alveolar septa. There are also accumulations of anthracotic pigment in this area (arrows).

This medium-power photomicrograph shows fibrosis and severe intimal changes in blood vessels (arrows).

This high-power photomicrograph shows intimal changes (arrows) in this blood vessel in the lung.

This is a high-power photomicrograph of a recanalized blood vessel in the lung. Notice the anthracotic pigment adjacent to the vessel (arrows).