Unusual Radiologic Findings in the Thorax after Radiation Therapy1
Benoît Mesurolle, MD ,
Salah Dine Qanadli, MD ,
Myriam Merad, MD ,
François Mignon, MD ,
Pierre Baldeyrou, MD ,
Anne Tardivon, MD ,
Pascal Lacombe, MD and
Daniel Vanel, MD
1 From the Departments of Radiology (B.M., F.M., A.T., D.V.), Hematology (M.M.), and Medicine (P.B.), Institut Gustave-Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif, France; and the Department of Radiology, Hôpital Ambroise Paré, Boulogne-Billancourt, France (S.D.Q., P.L.). Recipient of a Cum Laude award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 18, 1999; revision requested March 25 and received June 21; accepted June 21. Address reprint requests to B.M.
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Figure 1a. Pulmonary necrosis in a 48-year-old man after postoperative radiation therapy (60 Gy) for upper right bronchogenic carcinoma. (a, b) Chest radiograph (a) and computed tomographic (CT) scan (b) obtained 1 year after radiation therapy show fibrotic changes in the apex of the right lung. (c, d) Chest radiograph (c) and CT scan (d) obtained 2 years after radiation therapy show a large cavity with a sequestrum. Surgical exploration and histologic examination revealed changes due to radiation necrosis. Neither a bronchial fistula nor an associated infection was identified.
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Figure 1b. Pulmonary necrosis in a 48-year-old man after postoperative radiation therapy (60 Gy) for upper right bronchogenic carcinoma. (a, b) Chest radiograph (a) and computed tomographic (CT) scan (b) obtained 1 year after radiation therapy show fibrotic changes in the apex of the right lung. (c, d) Chest radiograph (c) and CT scan (d) obtained 2 years after radiation therapy show a large cavity with a sequestrum. Surgical exploration and histologic examination revealed changes due to radiation necrosis. Neither a bronchial fistula nor an associated infection was identified.
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Figure 1c. Pulmonary necrosis in a 48-year-old man after postoperative radiation therapy (60 Gy) for upper right bronchogenic carcinoma. (a, b) Chest radiograph (a) and computed tomographic (CT) scan (b) obtained 1 year after radiation therapy show fibrotic changes in the apex of the right lung. (c, d) Chest radiograph (c) and CT scan (d) obtained 2 years after radiation therapy show a large cavity with a sequestrum. Surgical exploration and histologic examination revealed changes due to radiation necrosis. Neither a bronchial fistula nor an associated infection was identified.
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Figure 1d. Pulmonary necrosis in a 48-year-old man after postoperative radiation therapy (60 Gy) for upper right bronchogenic carcinoma. (a, b) Chest radiograph (a) and computed tomographic (CT) scan (b) obtained 1 year after radiation therapy show fibrotic changes in the apex of the right lung. (c, d) Chest radiograph (c) and CT scan (d) obtained 2 years after radiation therapy show a large cavity with a sequestrum. Surgical exploration and histologic examination revealed changes due to radiation necrosis. Neither a bronchial fistula nor an associated infection was identified.
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Figure 2. BOOP in a 62-year-old woman with cough, dyspnea, and fever 2 months after radiation therapy to the right breast for breast carcinoma. CT scan of the chest obtained 9 months after completion of radiation therapy shows a lung infiltrate outside the radiation field. Surgical biopsy of the apical segment of the lower lobe was performed. Histologic analysis revealed the typical findings of BOOP. Corticosteroid therapy resulted in rapid clinical improvement and complete resolution of air-space areas of increased attenuation.
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Figure 3a. Thymic cyst in a 55-year-old woman 15 years after radiation therapy for breast cancer. T2-weighted magnetic resonance (MR) image (a) and CT scan (b) show a thymic cyst (arrows).
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Figure 3b. Thymic cyst in a 55-year-old woman 15 years after radiation therapy for breast cancer. T2-weighted magnetic resonance (MR) image (a) and CT scan (b) show a thymic cyst (arrows).
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Figure 4a. Lymph node calcifications in a 70-year-old woman after mediastinal irradiation for lymphoma. (a) Lateral chest radiograph obtained before radiation therapy shows a normal appearance (arrow). (b, c) Lateral chest radiographs obtained 13 years (b) and 28 years (c) after radiation therapy show mediastinal node calcification in the radiation field (arrows). The calcification increases in density over the years.
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Figure 4b. Lymph node calcifications in a 70-year-old woman after mediastinal irradiation for lymphoma. (a) Lateral chest radiograph obtained before radiation therapy shows a normal appearance (arrow). (b, c) Lateral chest radiographs obtained 13 years (b) and 28 years (c) after radiation therapy show mediastinal node calcification in the radiation field (arrows). The calcification increases in density over the years.
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Figure 4c. Lymph node calcifications in a 70-year-old woman after mediastinal irradiation for lymphoma. (a) Lateral chest radiograph obtained before radiation therapy shows a normal appearance (arrow). (b, c) Lateral chest radiographs obtained 13 years (b) and 28 years (c) after radiation therapy show mediastinal node calcification in the radiation field (arrows). The calcification increases in density over the years.
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Figure 5a. Vascular injury in a 36-year-old man after postoperative radiation therapy for bronchogenic carcinoma. Acute vena cava syndrome related to post-radiation therapy fibrosis occurred 5 years after completion of radiation therapy. (a) Posteroanterior chest radiograph shows chronic radiation changes with bilateral paramediastinal fibrosis. Note the metallic sternal prosthesis. (b) Phlebogram shows occlusion of the superior vena cava and left brachiocephalic vein, which led to venous thrombosis. (c, d) Angiograms show angioplasty (c) and placement of a Wallstent (d).
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Figure 5b. Vascular injury in a 36-year-old man after postoperative radiation therapy for bronchogenic carcinoma. Acute vena cava syndrome related to post-radiation therapy fibrosis occurred 5 years after completion of radiation therapy. (a) Posteroanterior chest radiograph shows chronic radiation changes with bilateral paramediastinal fibrosis. Note the metallic sternal prosthesis. (b) Phlebogram shows occlusion of the superior vena cava and left brachiocephalic vein, which led to venous thrombosis. (c, d) Angiograms show angioplasty (c) and placement of a Wallstent (d).
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Figure 5c. Vascular injury in a 36-year-old man after postoperative radiation therapy for bronchogenic carcinoma. Acute vena cava syndrome related to post-radiation therapy fibrosis occurred 5 years after completion of radiation therapy. (a) Posteroanterior chest radiograph shows chronic radiation changes with bilateral paramediastinal fibrosis. Note the metallic sternal prosthesis. (b) Phlebogram shows occlusion of the superior vena cava and left brachiocephalic vein, which led to venous thrombosis. (c, d) Angiograms show angioplasty (c) and placement of a Wallstent (d).
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Figure 5d. Vascular injury in a 36-year-old man after postoperative radiation therapy for bronchogenic carcinoma. Acute vena cava syndrome related to post-radiation therapy fibrosis occurred 5 years after completion of radiation therapy. (a) Posteroanterior chest radiograph shows chronic radiation changes with bilateral paramediastinal fibrosis. Note the metallic sternal prosthesis. (b) Phlebogram shows occlusion of the superior vena cava and left brachiocephalic vein, which led to venous thrombosis. (c, d) Angiograms show angioplasty (c) and placement of a Wallstent (d).
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Figure 6a. Vascular injury in a 69-year-old man after postoperative radiation therapy for thymoma. Coronal maximum intensity projection image (a) and coronal multiplanar reconstruction image (b) from CT scans show stenosis of the superior vena cava. Note the collateral network in a.
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Figure 6b. Vascular injury in a 69-year-old man after postoperative radiation therapy for thymoma. Coronal maximum intensity projection image (a) and coronal multiplanar reconstruction image (b) from CT scans show stenosis of the superior vena cava. Note the collateral network in a.
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Figure 7. Premature coronary artery stenosis in a nonsmoking 27-year-old man 14 years after radiation therapy for stage IV Hodgkin disease. Selective left coronary arteriogram shows a subocclusive ostial stenosis of the left main coronary artery (arrow). (Courtesy of Rémy Pillière, MD, Hôpital Ambroise Paré, Boulogne-Billancourt, France.)
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Figure 8. Chronic pericarditis in a 65-year-old man 12 years after radiation therapy for thymoma. CT scan of the chest shows pericardial thickening (arrows).
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Figure 9. Conduction abnormality in a 52-year-old woman 16 years after postoperative radiation therapy for cancer of the left breast. Radiograph shows a pacemaker, which was implanted to control cardiac arrhythmia. Note the post-radiation therapy changes in the left shoulder.
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Figure 10a. Breast cancer in a 47-year-old woman who was treated for Hodgkin disease at the age of 23 years. At clinical examination, there was a palpable nodule in the upper inner quadrant of the right breast, which represented an infiltrating ductal carcinoma. (a) Lateral mammogram shows a spiculated area of increased opacity. (b) Original pretreatment photograph shows the radiation fields for treatment of the Hodgkin disease (breast dose, 8-49 Gy). The site of the future breast cancer (arrow) overlaps the radiation field.
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Figure 10b. Breast cancer in a 47-year-old woman who was treated for Hodgkin disease at the age of 23 years. At clinical examination, there was a palpable nodule in the upper inner quadrant of the right breast, which represented an infiltrating ductal carcinoma. (a) Lateral mammogram shows a spiculated area of increased opacity. (b) Original pretreatment photograph shows the radiation fields for treatment of the Hodgkin disease (breast dose, 8-49 Gy). The site of the future breast cancer (arrow) overlaps the radiation field.
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Figure 11a. Osteosarcoma in a 60-year-old man 15 years after postoperative radiation therapy (60 Gy) for bronchogenic carcinoma. (a) Clinical photograph shows a soft-tissue mass within the radiation field. (b) CT scan at the level of the sternal manubrium shows bone destruction and the soft-tissue mass.
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Figure 11b. Osteosarcoma in a 60-year-old man 15 years after postoperative radiation therapy (60 Gy) for bronchogenic carcinoma. (a) Clinical photograph shows a soft-tissue mass within the radiation field. (b) CT scan at the level of the sternal manubrium shows bone destruction and the soft-tissue mass.
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Figure 12a. Bone metastasis in a 51-year-old woman 10 years after radiation therapy for breast carcinoma. (a) CT scan of the chest shows destruction of the manubrium and a soft-tissue mass within the radiation field. (b) Sagittal T1-weighted MR images of the chest wall show an abnormal soft-tissue mass replacing the manubrium. The initial diagnosis was solitary bone metastasis or radiation-induced sarcoma. CT-guided
biopsy demonstrated a metastasis from breast carcinoma.
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Figure 12b. Bone metastasis in a 51-year-old woman 10 years after radiation therapy for breast carcinoma. (a) CT scan of the chest shows destruction of the manubrium and a soft-tissue mass within the radiation field. (b) Sagittal T1-weighted MR images of the chest wall show an abnormal soft-tissue mass replacing the manubrium. The initial diagnosis was solitary bone metastasis or radiation-induced sarcoma. CT-guided
biopsy demonstrated a metastasis from breast carcinoma.
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Figure 13a. Severe benign bone changes in an 8-year-old boy 6 years after radiation therapy for Ewing sarcoma of a rib. (a) CT scan obtained before radiation therapy shows a postoperative rib fracture (arrow). (b) CT scan of the chest shows an abnormal callus with an ossified soft-tissue mass. Histologic examination after open biopsy demonstrated a massive, calcified callus with radionecrosis. (c) Coronal T1-weighted spin-echo MR image shows hyperintense bone marrow, which corresponds to the radiation field (ie, posttherapy conversion of hematopoietic marrow to fatty marrow). (d) Coronal T1-weighted spin-echo MR image shows the abnormal callus (arrows).
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Figure 13b. Severe benign bone changes in an 8-year-old boy 6 years after radiation therapy for Ewing sarcoma of a rib. (a) CT scan obtained before radiation therapy shows a postoperative rib fracture (arrow). (b) CT scan of the chest shows an abnormal callus with an ossified soft-tissue mass. Histologic examination after open biopsy demonstrated a massive, calcified callus with radionecrosis. (c) Coronal T1-weighted spin-echo MR image shows hyperintense bone marrow, which corresponds to the radiation field (ie, posttherapy conversion of hematopoietic marrow to fatty marrow). (d) Coronal T1-weighted spin-echo MR image shows the abnormal callus (arrows).
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Figure 13c. Severe benign bone changes in an 8-year-old boy 6 years after radiation therapy for Ewing sarcoma of a rib. (a) CT scan obtained before radiation therapy shows a postoperative rib fracture (arrow). (b) CT scan of the chest shows an abnormal callus with an ossified soft-tissue mass. Histologic examination after open biopsy demonstrated a massive, calcified callus with radionecrosis. (c) Coronal T1-weighted spin-echo MR image shows hyperintense bone marrow, which corresponds to the radiation field (ie, posttherapy conversion of hematopoietic marrow to fatty marrow). (d) Coronal T1-weighted spin-echo MR image shows the abnormal callus (arrows).
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Figure 13d. Severe benign bone changes in an 8-year-old boy 6 years after radiation therapy for Ewing sarcoma of a rib. (a) CT scan obtained before radiation therapy shows a postoperative rib fracture (arrow). (b) CT scan of the chest shows an abnormal callus with an ossified soft-tissue mass. Histologic examination after open biopsy demonstrated a massive, calcified callus with radionecrosis. (c) Coronal T1-weighted spin-echo MR image shows hyperintense bone marrow, which corresponds to the radiation field (ie, posttherapy conversion of hematopoietic marrow to fatty marrow). (d) Coronal T1-weighted spin-echo MR image shows the abnormal callus (arrows).
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Figures 14. Severe benign bone changes in a 37-year-old man 3 years after postoperative radiation therapy (65 Gy) for upper right bronchogenic carcinoma. Radiograph of the ribs and shoulder shows rib fractures with severe bone changes. Note the subcutaneous emphysema (arrows).
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Figure 15. Rib fracture in a 47-year-old woman 12 years after radiation therapy for inflammatory cancer of the left breast. Close-up radiograph shows a fracture of the anterior aspect of the left third rib with nonunion (arrow).
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Copyright © 2000 by the Radiological Society of North America.
