The Case Files

Abstract

A 57-year-old man with a past medical history of prostate cancer presented to the emergency department with a one-day history of fever, chills, and left lower quadrant abdominal pain. His temperature was 102.1°F, and his abdomen was moderately tender in the left lower quadrant with no associated peritoneal signs. The patient denied any chest pain, shortness of breath, diarrhea, constipation, or urinary symptoms including dysuria, increased frequency, or urgency. An acute abdominal series was obtained in the emergency department, and it incidentally revealed embolization of the patient's prostatic brachytherapy seed implants to his lungs. Radioactive seed migration from prostate brachytherapy was first described by Steinfield et al in 1991, and is well known in radiation oncology. Numerous reports of radioactive seed migration now exist in the literature. Pulmonary embolization of seed implants has an estimated incidence of two to 21.8 percent. The primary adverse effect of seed migration is the potential reduction in radiation dose to the prostate, potentially affecting cancer treatment. No adverse effects related to the lung have been reported, and most believe that pulmonary embolization of prostatic brachytherapy seed implants is not harmful to lung function or structure.Figure: PA chest x-ray showing prostatic brachy-therapy seeds embolized into the lungs.Other case reports have described seed migration to the left renal vein, left renal artery, vertebral venous plexus, liver, and heart. The patient in this case denied any respiratory complaints such as cough, shortness of breath, chest pain, or hemoptysis, so the focus of his medical treatment was centered on his abdominal pain. The patient underwent a CT scan of the abdomen and pelvis, which revealed acute diverticulitis. He received intravenous antibiotics, was admitted to the hospital, and was discharged several days later after an uncomplicated hospital stay.Figure: CT chest scan showing prostatic brachy-therapy seeds embolized into the lungs.Figure: KUB showing a non-obstructive bowel gas pattern.Figure: Bladder shot showing brachytherapy seed implants in the prostate.