Pathology of radiation induced heart disease

The aim of this paper is dual - to review the relevant literature on pathology of radiation induced heart disease (RIHD), and to present an illustrative case of our own. Therapeutic ionizing radiation, such as that used in the treatment of Hodgkin´s lymphoma and cancers of left breast, lungs, esophagus, and thymus, can cause cardiac damage that may take several years to manifest. The spectrum of RIHD is broad and includes [1] pericarditis and pericardial effusion; [2] endocardial fibrosis and valvular dysfunction; [3] nonischemic myocardial fibrosis; [4] obstructive coronary artery disease with resultant myocardial ischemia; [5] damage to the great vessels; and [6] conduction system dysfunction. Pericardial disease, however, is the most common manifestation of mediastinal irradiation. A case is described of a typical RIHD in a 52-year-old female who died from heart failure with a history of mediastinal neuroblastoma operated and irradiated at the age of 9 years. Her autopsy heart lesions comprised chronic and acute pericarditis with constrictive features, myocardial fibrosis with features of restrictive cardiomyopathy and fibrosis with calcification of the left heart valves. As a unique lesion, there were small calcifications in the mural endocardium and in the large arterial intima. This finding seems to be diagnostic for RIHD.