대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 176 Date 2001-03-10

  • Courtesy of Sang Jin Kim, M.D. / Yongdong Severance Hospital, Seoul, Korea
  • Age/Sex 63 / F
  • Chief ComplaintDyspnea on exertion for 15 days. On medication due to atrial fibrillation The first chest radiograph, which is normal, was obtained four months ago.
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Diagnosis With Brief Discussion

Diagnosis
Amiodarone-induced pulmonary toxicity
Radiologic Findings
Follow-up chest radiograph shows multifocal patchy areas of consolidation with reticulation in both lungs.

HRCT scans show multifocal areas of consolidation, ground-glass attenuation, and irregular linear opacities in both lungs. Mild bronchial dilatation is noted within the consolidation.

CT scans with mediastinal window setting show mild pleural thickening and parenchymal lesions of relatively high attenuation.
Brief Review
Amiodarone hydrochloride (Cordane) is an effective antiarrhythmic drug that can cause fatal pneumonitis.
The drug usually accumulates in the liver and in the lung, where its half-life is extremely long (25-60 days).
The reported prevalence of pulmonary toxicity in the patients receiving amiodarone ranges from 1.4% to 18%.
Mortality due to pulmonary toxicity is as high as 20-30%.
Clinical indications of amiodarone toxicity range from acute onset of pleuritic chest pain and shortness of breath to more indolent symptoms of malaise, fever, cough and dyspnea.

Conventional radiographic findings are area of consolidation, infiltration, or interstitial disease, findings that are entirely nonspecific and easily confused with pulmonary abnormalities caused by congestive heart failure, pneumonia and pulmonary infarction.
Ga-67 imaging has been used to detect amiodarone toxicity, but although very sensitive to inflammation, Ga-67 imaging is not disease or drug specific.

CT findings indicative of significant amiodarone exposure included high-attenuation parenchymal-pleural lesion, and increased liver and/or spleen attenuation.
CT findings of high attenuation parenchymal pleural abnormalities are thought to be related to the iodinated chemistry of the drug and its prolonged half-life within the lung.
References
1. Nicholson AA, Hayard C. The value of computed tomography in the diagnosis of amiodarone-induced pulmonary toxicity. Clin Radiol 1989;40:564-567
2. Padley SPG, Adler B, Hansell DM. High resolution computed tomography pf drug-induced lung disease. Clin Radiol 1992;46:232-236
3. Kuhlman JE. The role of chest computed tomography in the diagnosis of drug related reactions. J Thorac Imag 1991;6:52-61
4. Ren H, Kuhlman JE, Hruban RH, Kishman EK, Wheeler PS, Hutchins GM. CT-pathologic correlation of amiodarone lung. JCAT 1990;4:760-765
5. Marchlinski FE, Gansler TS, Waxman HL, Josepson ME. Amiodarone pulmonary toxicity. Ann Intern Med 1982;97:839-845
6. Moinuddine M, Rockett J. Gallium scintigraphy in the detection of amiodarone lung toxicity. AJR 1986;147:607-609
7. Kennedy JI, Meyers JL, Plumb VJ, Fulmer DJD. Amiodarone pulmonary toxicity: Clinical radiologic and pathologic correlation. Arch Intern Med 1987;147:449-471
8. Kuhlman JE, Teigen C, Ren H, Hruban RH, Hutchins GM, Fishman EK. Amiodarone pulmonary toxicity: CT findings in symptomatic patients. Radiology 1990;177:121-125
Keywords
Lung, Interstitial lung disease, Drug complication, ILD,

No. of Applicants : 40

▶ Correct Answer : 35/40,  87.5%
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  • - 諛•
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  • - 11th Air Force Hospital Byung-June Jo
  • - AZ vesalius Tongeren, Belgium Rudi Stokmans
  • - CHU Nancy-Brabois France Denis Regent
  • - Dong-A University Hospital Ki-Nam Lee
  • - KyungHee medical center Ko, Kyunglan
  • - Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
  • - Ospedale di Fabriano, Italy Giancarlo Passarini
  • - Paris, France Pierre-Yves Brillet
  • - Santa Maria delle Grazie Hospital-Pozzuoli, Naples, Italy Bianca Cusati
  • - Seoul City Boramae Hospital Jae-Woo Song
  • - Seoul National University Hospital Tae Jung Kim
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
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