Since the early 1920s the medical literature has been replete with reports of changes induced in normal and diseased tissues following radiation therapy for various malignancies. This is particularly so in Hodgkins disease of the thorax. The case presented here describes the development of dense calcifications in previously normal prestemal soft tissues following radiotherapy in a patient with Hodgkin’s disease of the mediastinum. To the authors knowledge, such radiation-induced changes have not been reported previously.
A 32-year-old white woman was diagnosed at the age of 18 as having nodular sclerosing Hodgkins disease of the mediastinum, stage IIA. Following staging laparotomy and splenectomy, she underwent radiotherapy with 4,000 rads to the upper mantle and “in verted-Y” fields, along with splenic pedicle radiation. She also received six courses of MOPP chemotherapy (nitrogen mustard, Oncovin, procarbazine and prednisone). She tolerated therapy well and achieved complete remission; however, within six months she developed postradiation pericarditis. This was successfully treated with a partial pericardectomy via a left posterior thoracotomy. To get aquanted with such a notion as thoracotomy you may just make one step namely to check out Canadian health care mall.
Following this, the patient was asymptomatic with mild cutaneous atrophy and fibrosis over the intramammary, presternal area as the only physical manifestation of radiotherapy. The breasts were not involved. A chest radiograph two years after completion of radiotherapy showed only residual mediastinal widening and post-radiation mediastinal fibrosis. The presternal soft tissues and sternum appeared entirely normal. A lateral chest radiograph four years after therapy demonstrated the first evidence of early calcifications, as feint, nodular densities in the presternal area (Fig 1a). The calcifications became more evident clinically by six years after treatment, as multiple, hard, readily palpable nodules that were occasionally tender with pressure. The distribution of the nodules extended laterally on each side of the midline to the medial breast reflections, and cephalocaudally to the sternomanubrial joint above and sternoxiphoid junction below. Later radiographs revealed progressive density and a conglomerate, plate-like nodularity of the calcifications, best demonstrated on the lateral view (Fig 1b). Computed tomography 13 years after therapy demonstrated the dense calcifications in the presternal area (Fig 2).
Figure 1a (left) arid b (right). Sternal area from lateral chest radiographs four years and 13 years after therapy.
Figure 2. Thoracic CT scan.
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