대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Courtesy

Kyung Hee University Hospital, Korea

Past History

Mitral valve replacement 22 months ago, Amiodarone 400mg/day after MVR

Reviewy

Amiodarone hydrochloride (Cordarone￠c)

Effective antiarrhythmic drug
Benzofuran derivatives (thyroxine) : iodine content
Accumulate in the liver and lung(half-life is extremely long:15-60 ds)
Adverse effect: corneal microdeposit, grey-blue skin discoloration,
pph. neuropathy, weakness, nausea, bradycardia, hypo- or hyperthyroidism


Pulmonary toxicity : most severe Cx

Incidence : 5-10%
Mortality rate : 10-20%
Daily dose > 600~800 mg (No correlation with total accumulative dose)
Occur between 6 days to 60 months (Highest incidence during the first 12 months)

Clinical presentation

Dyspnea, cough and even to ARDS

Radiographic findings

Nonspecific
Consolidation, infiltration, interstitial disease
NSIP: most common manifestation
BOOP: less common
Pleural effusion: pleural inflammation

CT findings

High-attenuation area of peripheral consolidation: Foamy macrophages in the interstitium and alveolar space
Also seen in liver and spleen
Reticular opacities or GGO

Treatment

Stop amiodarone
Corticosteroid

Prognosis

Good, improving after discontinuation


Resolution of abnormal radiologic findings

After 2-12 months
Do not correlate with clinical improvemen

Keywords

Lung, Interstitial lung disease, Drug induced pulmonary toxicity,