Chronic Radiodermatitis over Left Elbow and Left Chest Wall after Cadiac Angiography-A Case Report

Abstract

Background:Cardiac angiography is one of the most common diagnostic and therapeutic procedures for heart diseases. It produces high dose of radiation exposure. The subsequent skin injury might result in radiodermatitis.Aim and Objectives:Radiodermatitis after cardiac angiography has been reported over axilla or upper back areas. In this paper, we present a rare case of radiodermatitis with relenting pain over both left elbow and left lateral chest wall after 3 repeated and prolonged cardiac angiography.Materials and Methods:A 64-year-old man received 3 times of cardiac angiography in 3 years for his coronary arterial disease. Percutaneous coronary angioplasty was intended during the third cardiac angiography which resulted in prolonged procedure for more than 4 hours. A skin lesion, measured 10 X 8 cm2, was noted with a central ulcer for one year after the last cardiac angiography. Despite various local wound treatments, the wound healed poorly, and the pain persisted. Total excision of the skin lesion and reconstruction with a pedicled radial forearm flap was performed with favorable result. A separative chronic ulceration developed over left chest wall half a year later. Successful treatment was achieved with total excision of the ulcerative lesion and local flap coverage. For both lesions, histopathological findings revealed dermal and epidermal necrosis with fibrosis, which was compatible with chronic radiation injury and secondary ulceration.Results:The painful sensation relieved after the surgery, and the patient had full recovery after the reconstruction in two years follow-up.Conclusion:Chronic radiodermatitis after cardiac angiography with interventions is uncommon, but the incidence is rising with the increasing number and complexity of these procedures. In this case report, excision of ulcerative lesions with flap coverage provided symptom relief and good wound healing. (J Taiwan Soc of Plast Surg 2011; 20: 309∼315)