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Weekly Chest CasesArchive of Old Cases

Case No : 704 Date 2011-04-25

  • Courtesy of Mi Joo Choi MD, Sung Shine Shim MD, PhD. / Mok Dong Hospital, Ewha Womans University
  • Age/Sex 66 / F
  • Chief ComplaintDyspnea and cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Amiodarone-induced pulmonary toxicity
Radiologic Findings
Chest simple radiography (Figure 1) shows subpleural consolidations in both lungs with bilateral pleural effusions. Non-contrast CT scans (Figure 2 & 3) demostrate subpleural consolidations and GGOs in both lungs, especially both lower lobes, of which attenuation is higher than vascular attenuation in the mediastinum (Figure 4). The attenuation of the liver is high on non-contrast CT (Figure 5), raising the suspicion of iodine deposition in patients with history of amiodarone medication.
The patient has been treated with amiodarone because of atrial fibrillation for 1 year. Treatment was the cessation of amiodarone medication. On three months follow up (Figure 6), the consolidation is markedly decreased in extent in this patient.

Figure 5

Figure 6

Brief Review
Amiodarone is an iodinated compound used to treat life threatening cardiac dysrrhythmia, pulmonary toxicity occurs in 5 to 10% of treated patients. Toxicity is dose related and is more likely to occur with doses greater than 400 mg/day.
The most common clinical presentation consists of subacute onset of nonproductive cough, dyspnea, and weight loss; this presentation appears on HRCT 1) Commonly, as diffuse interstitial thickening and interstitial fibrosis (NSIP predominantly composed of mononuclear cells, foamy alveolar macrophages, type II cell hyperplasia, and fibrosis), 2) Less commonly, as nodular areas of subpleural consolidation (bronchiolitis obliterans organizing pneumonia). Another less common presentation consists of acute onset of dyspnea associated with fever; this presentation appears on HRCT as areas of dependent consolidation. Amiodarone is an iodine-containing compound; therefore, parenchymal lesions often show high attenuation, with a range from 82 to 174 HU. Although this finding is helpful in suggesting amiodarone-induced pulmonary toxicity, it is not pathognomonic. Discontinuation of therapy typically is associated with a good prognosis.
References
1. Edson Marchiori, Arthur S. Souza, Jr., Tom? Franquet, Nestor L. M?ler, Diffuse High-Attenuation Pulmonary Abnormalities: A Pattern-Oriented Diagnostic Approach on High-Resolution CT. AJR 2005; 184: 273-282
2. Samantha J. Ellis, Joanne R. Cleverley, Nestor L. M?ler, Drug-Induced Lung Disease: High-Resolution CT Findings. AJR 2000; 175: 1019-1024
Keywords
Lung, Multiple organ, Iatrogenic lung disease, Drug complication,

No. of Applicants : 91

▶ Correct Answer : 59/91,  64.8%
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - SMC , Korea (South) Yi Kyung Kim
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - Okayama University , Japan Akihiro Tada
  • - Severance hospital , Korea (South) Saerom Hong
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Saga University , Japan Tetsuya Kondo
  • - chungbuk uni. hospital , Korea (South) JY Ahn
  • - chp st martin , France Mariotte benoit
  • - National Jewish Health , United States Jonathan Chung
  • - Catholic medical center , Korea (South) hyuna kim
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - CHRU lille , France manuel toledano
  • - Virginia Mason , United States Elliott Mueller
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Saga University , Japan Ryoko Egashira
  • - Gangnam Severance Hospital , Korea (South) Sung Ho Hwang
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - NTUH , Taiwan Sheng-Kai Liang
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Chonnam National University Hospital , Korea (South) Daun Lee
  • - Istanbul , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Doctors Hospital , Bahamas muneesh sharma
  • - NEPEAN HOSPITAL , Australia YOGESH THAKKAR
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - Consultant Radiologist, London , United Kingdom Shekhar Banavali
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - Chung-Nam National University Hospital , Korea (South) KI-TAE HAN
  • - Sanggye paik hospital , Korea (South) Gyungmin Park
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - clcc Rennes , France nicolas gautier
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Saint Malo , France jean-baptiste Noel
  • - IRSA , France jean-luc BIGOT
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
▶ Correct Answer as Differential Diagnosis : 2/91,  2.2%
  • - NTUH , Taiwan Kuei-pin Chung
  • - HIA Desgenettes , France Francois Le Moigne
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