A Unique and Extensive Constellation of Late Radiation Effects in a Single Patient Following High-Dose Radiation Therapy for Childhood Hodgkin’s Lymphoma

Childhood cancer survivors treated with large-field radiation may develop late secondary effects across multiple organ systems. We present a 60-year-old male whose PET/CT revealed an absent thyroid gland with multiple metastatic foci, a surgically absent spleen and bladder with an ileal conduit, severe pulmonary outflow tract calcifications, and transcatheter aortic valve replacement (TAVR), bilateral proximal humeral osteonecrosis, and bilateral total hip arthroplasties. Though each individual finding may be readily recognizable on imaging, the key to this case is interpreting the constellation of findings as potential late effects of radiation therapy (RT), especially since severe pulmonary artery calcifications and multifocal osteonecrosis involving both shoulders and hips due to RT are exceedingly rare. Review of the patient's medical history, obtained only after persistent follow-up with the treating facility, revealed prior high-dose, large-field external beam radiation for stage IIIA childhood Hodgkin's lymphoma, administered in the 1970s. Awareness of these characteristic sequelae allows medical providers to correctly contextualize seemingly disparate findings, particularly when the details of prior radiation history are not readily available.