Radiation-induced ‘pancarditis’

A 69-year-old woman was hospitalised with exertional dyspnea and edema in lower extremities. She had undergone left partial mastectomy for breast cancer 35 years previously, followed by chemotherapy and adjuvant radiation with a total dose of 60 Gy/28 fr. Multimodality imaging (Figure 1, Supplementary Videos A2 and A3) with transthoracic echocardiogram, computed tomography scan, cardiac magnetic resonance imaging, coronary arteriography and 24-h Holter monitoring revealed multivalvular disease, constrictive pericarditis, cardiomyopathy, coronary artery disease and malfunction of sinus node, suggesting the diagnosis of late development of post radiation-induced ‘pancarditis’ [1,2]. Multimodality paraclinical work-up of the patient with transthoracic echocardiography (A–D), electrocardiogram (E), thoracic computed-tomography scan (F), cardiac magnetic resonance imaging (G, H) and coronary arteriography (I) revealing findings compatible with post radiation-induced ‘pancarditis’. Multimodality paraclinical work-up of the patient with transthoracic echocardiography (A–D), electrocardiogram (E), thoracic computed-tomography scan (F), cardiac magnetic resonance imaging (G, H) and coronary arteriography (I) revealing findings compatible with post radiation-induced ‘pancarditis’. In such cases, detailed clinical history remains the mainstay of diagnosis which should be supported by multimodality imaging. Physicians should be aware of late sequelae of chest radiation for conditions such as breast cancer and lymphoma, especially when the patient’s medical history includes high cumulative dose of radiation (>30 Gy), younger age (<50) at time of radiation therapy and concomitant chemotherapy. Written informed consent for publication of their clinical details and images was obtained from the patient. None. None.