Prostate brachytherapy seed migration to the right coronary artery associated with an acute myocardial infarction.
OBJECTIVE
We report a case of prostate brachytherapy seed migration to the right coronary artery (RCA) associated with an acute myocardial infarction (AMI).


METHODS
A 69-year-old male was diagnosed with Prostate Adenocarcinoma Stage II (T(1c)N0M0) in October 2003. He underwent percutaneous transperineal interstitial permanent prostate brachytherapy with the implantation of 94 loose iodine (125I) seeds under transrectal ultrasound guidance on 15 December, 2003. The implantation was designed to deliver a minimum dose of 144 Gy.


RESULTS
Postimplant pelvic radiography at Day 30 showed five seeds missing. No chest radiography was done until hospital admission on October 10, 2005 for AMI. Cine radiography from cardiac catheterization revealed 86 metallic seeds remaining in the pelvic region, 4 that had migrated to the lungs (2 left and 2 right) and 2 to the heart. Two seeds were unaccounted for. Of the two cardiac seeds, one was lodged in the right ventricle endocardium and the other in the midsegment of the RCA at the site of a severely stenotic lesion that resulted in an AMI.


CONCLUSIONS
To our knowledge, this is the first case of brachytherapy seed migration to the RCA associated with an AMI. Echocardiography before brachytherapy seed implantation might be considered in patients felt to be at high risk for cardiac shunting.
Zhu
Alan X
AX
Cardiology Division, Loma Linda University Medical Center, Loma Linda, CA, USA.
Wallner
Kent E
KE
Frivold
Geir P
GP
Ferry
David
D
Jutzy
Kenneth R
KR
Foster
Gary P
GP
D000230:Adenocarcinoma / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D002933:Cineradiography; D017023:Coronary Angiography; D003331:Coronary Vessels; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*
D007457:Iodine Radioisotopes