The Effects of Thorium Dioxide Sol (Thorotrast) on the Human Liver

Abstract

Introduction THE usefulness of thorium dioxide sol in the roentgen diagnosis of diseases of the liver and spleen has been well demonstrated by numerous articles in the recent medical literature (23, 24, 15, 16, 7, 33, 13). Its utility, however, has been greatly restricted by the fear, which has been so frequently expressed, that ill effects may follow its injection. The dangers associated with the use of this substance have been abundantly described and numerous conflicting opinions have been presented regarding the justification for its employment. While the original protagonists for the utilization of this colloidal suspension of thorium dioxide (thorotrast), Radt (24) and Kadrnka (16), apparently are satisfied that it presents no real danger; others, such as Anders and Leitner (1), Büchner (2), Cooke (4), Hanke (8), Shute and Davis (29), Pohle and Ritchie (21) and others, criticize the use of this material most emphatically. Naegeli and Lauche (20) take a middle ground, while numerous other authors, such as Ravenna (26), Tripoli (30), Tripoli, Haam and Lehman (32), Irwin (14), Yater and Otell (33), Ericksen and Rigler (7), Hirsch and Morton (13), and others believe there is relatively little harm produced by this procedure, if the opaque substance is given in moderate doses. The dangers inherent in this method of roentgen diagnosis may be divided into a number of categories. There are, first, the usual accompaniments to the intravenous injection of any substance, particularly a colloid. The immediate effects, such as rise in temperature, slight nausea, flushing, etc., have been previously described (7) and are of no particular consequence. The hemoclastic effect of the injection of colloids has been emphasized by Shih and Jung (28). Our experience, and that of many others, would seem to indicate that these hemoclastic crises, which Stewart, Einhorn, and Illick (27) encountered, are due either to unstable or poorly prepared material or to the use of enormous doses. As stated in a previous publication (7), we have had only one such experience and this was later proved to be due to a faulty preparation. One case of death from anuria—a possible sequence to injection of a colloid—has been reported (34), but in this case a transfusion had also been given, so there is serious doubt as to the culpability of the thorium preparation. Some transient anuria, however, has occurred in dogs after the injection of thorium dioxide sol. We have had no such experience either in animals or amongst the 175 patients upon whom we are here reporting. The possibility of rupture of the spleen has been considered because of the report of Büngeler and Krautweig (3), who gave a fairly large dose of thorium dioxide sol to a patient with severe reticulo-endotheliosis. A massively enlarged, very soft spleen was present and rupture occurred, with a fatality resulting.