Usefulness of Extremity Arteriography in Special Situations

Cerebral and renal arteriography are well established clinical procedures in the diagnosis of malignant tumors, and arteriography of other retroperitoneal and intraperitoneal viscera is “coming-of-age.” It is surprising that vascular studies of extremity tumors, one of the first areas of investigation to which arteriography was applied, are not yet routine even in many of the more advanced clinical centers (1, 3). The literature which does exist on this subject suggests that arteriography might be very helpful in differentiating benign from malignant extremity lesions, in selecting biopsy sites, and in defining the extent of tumors (3, 5–7, 15, 18, 19). In our experience with arteriography of peripheral tumors, we have come to feel that these assertions are valid within certain limitations. Furthermore, it has been suggested that arteriography might give early objective evidence of a response to therapy when vascular malignant tumors of the extremities are treated by irradiation (3, 14, 15, 18, 19). Selected case reports from our series will illustrate some of these points. Case Reports Case I: A 75-year-old woman was first admitted on Jan. 13, 1964, with a history of pain and swelling in the right shoulder of four months duration. Examination showed diffuse swelling about the shoulder, with increased temperature of the skin and prominence of the veins. The shoulder was mildly tender, and motion was limited by pain. The right radial pulse was weaker than the left, and there was decreased muscle strength in the right arm and hand. Plain films showed extensive bone destruction in the upper humerus, with a pathological fracture and a large surrounding soft-tissue mass. Right brachial arteriography, performed by cutdown of the artery and insertion of a Teflon catheter to the level of the third portion of the subclavian artery, disclosed a highly vascularized soft-tissue mass about the right shoulder (Fig. 1,A).3 Numerous malignant-appearing vessels were present in this lesion. A diffuse vascular tumor stain persisted for several seconds after the venous phase of the arteriogram. Biopsy of the shoulder was reported as consistent with osteogenic sarcoma. A tumor dose of 6,000 R was given in seventeen days, with a 2 Mv van de Graaff machine. A repeat right brachial arteriogram, three months after completion of radiotherapy, showed numerous avascular areas within the soft-tissue mass, consistent with tumor necrosis (Fig. I,B). The patient is alive with residual disease, but gaining weight and feeling well fifteen months after the completion of radiation therapy. Case II: This 12-year -old girl was first admitted on Feb. 17, 1964. She had fallen the day before admission and had experienced continuous pain in the right hip and thigh since then. Temperature on admission was normal. Physical examination revealed only mild tenderness over the distal right femur.