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Fatal abdominal thorotrast granuloma
H Ishii1, A Tanaka, Y Nakayama
1Division of Internal Medicine, Moji Rosai Hospital, Kitakyushu, Japan.
Insights
A rare abdominal thorotrast granuloma, developing 49 years after a procedure, caused fatal ureteral obstruction, venous thrombosis, and organ perforation. This case highlights the severe, long-term risks of thorotrast exposure.
Area of Science:
- Radiology and Pathology
- Toxicology and Long-term Health Effects
Background:
- Thorotrast, a historically used radiographic contrast agent, poses long-term health risks due to its radioactive nature.
- Delayed complications from thorotrast deposition can manifest decades after exposure.
Observation:
- A 65-year-old man presented with symptoms stemming from a large abdominal thorotrast granuloma.
- The granuloma developed 49 years after accidental extravasation during a femoral angiography procedure.
Findings:
- The growing thorotrast granuloma led to critical complications, including ureteral obstruction, venous thrombosis, and perforation of the urinary bladder and rectum.
- This represents the first documented instance of a thorotrast granuloma causing perforation through both the urinary bladder and rectum.
Implications:
- This case underscores the critical importance of recognizing the potential for severe, delayed complications from historical thorotrast use.
- It highlights the need for vigilance in diagnosing and managing rare granulomatous diseases, even many years after initial exposure.
- The findings emphasize the severe morbidity associated with thorotrast-induced granulomas, particularly when they lead to organ perforation.
Abstract:
We report a case of fatal abdominal thorotrast granuloma seen in a 65-year-old man who had undergone a femoral angiography of thorotrast with some accidental extravasation 49 years previously. As the thorotrast granuloma gradually increased in size, it caused ureteral obstruction, venous thrombosis, and perforation of the urinary bladder and rectum. Symptomatic abdominal thorotrast granuloma is quite rare and this is the first reported case of the granuloma associated with perforation through the urinary bladder and rectum.