Chronic radiodermatitis following cardiac catheterisation: a report of twocases and a brief review of the literature

Cardiac angiography produces one of the highest radiation exposures of any commonly used diagnostic x ray procedure. Recently, serious radiation induc ed skin injuries have been reported after repeated therapeutic intervention al procedures using prolonged fluoroscopic imaging. Two male patients, aged 62 and 71 years, in whom chronic radiodermatitis developed one to two year s after two consecutive cardiac catheterisation procedures are reported. Bo th patients had undergone lengthy procedures using prolonged fluoroscopic g uidance in a limited number of projections. The resulting skin lesions were preceded, in one case, by an acute erythema and took the form of a delayed pigmented telangiectatic, indurated, or ulcerated plaque in the upper back or below the axilla whose site corresponded to the location of the x ray t ube during cardiac catheterisation. Cutaneous side effects of radiation exp osure result from direct damage to the irradiated tissue and have known thr esholds. The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and c areful medical history. Interventional cardiologists should be aware of thi s complication, because chronic radiodermatitis may result in painful and r esistant ulceration and eventually in squamous cell carcinoma.