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Cutaneous radiation syndrome in multi-organ failure

Hospital and Clinic of Vascular Surgery and Dermatology, Erhard-Groezinger-Strasse 102, D-89134 Ulm-Blaustein, Germany

View larger version (86K): [in a new window]   Figure 1. Manifestation stage of the cutaneous radiation syndrome (CRS). (A) Schematic drawing of the pathophysiological processes involved. (B) Clinical aspect of a manifestation stage, 24 h after accidental exposure of the lateral thorax to a cutaneous dose of 60 Gy of photons. An eroded blister and sterile pustules can be seen (iatrogenic accident in Germany, 1994). (C) High frequency ultrasound of manifestation stage on the upper arm, showing decreased dermal echogenicity as a sign of inflammatory interstitial oedema (Georgian accident, 1997). (D) Thermographic images of the back of a victim with an inflammatory reaction (Courtesy of Prof. J M Cosset, Institut Curie, Paris) (Georgian accident, 1997). (E) Ulcerative manifestation stage, suprapatellar region (Georgian accident, 1997).

View larger version (73K): [in a new window]   Figure 2. Chronic stage of the cutaneous radiation syndrome (CRS). (A) Schematic drawing of the pathophysiological processes involved. (B) Clinical aspect of the chronic stage, 6 years after exposure (lower leg of a survivor of the accident in Chernobyl (1986), documented 1992). Note the focal radiation keratosis (benign on biopsy), telengiectasias and severe fibrosis next to epidermal atrophy. (C) Histopathology of radiation fibrosis: loss of epidermal rete-ridges, flattening of the epidermis, homogeneous collagenisation and scarce perivascular lymphocytic infiltrate. Biopsy taken from the back of a Chernobyl survivor in 1993. (D) High frequency ultrasound of chronic stage (lower leg of a Chernobyl survivor, documented in 1993) prior to treatment with interferon-. An extremely increased echogenicity from the epidermal entrance echo down to the muscle fascia indicates severe radiation fibrosis.