Management of cervical thorium dioxide granulomas

Thorium dioxide (Thorotrast) was used extensively in the United States from the 1930s through the 1950s for contrast radiography, including cerebral angiography. Its use was discontinued after the pathologic consequences of tumor formation and local fibrotic reaction (thorium dioxide granuloma) were recognized. The latency period for the development of these consequences is 20 to 30 years and, thus, has not expired. Radical surgical excision in an attempt to remove cervical thorium dioxide granulomas and their ionizing radiation has been advocated previously. A case prompted reconsideration of this management. Total surgical removal does not seem possible and is extremely hazardous in those cases with a patent carotid artery adjacent to the cervical granuloma. More cases should be expected, and each case should be approached individually as to benefits and risks of attempted surgical removal of the granuloma. Radical surgery is not always the treatment of choice.