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Weekly Chest CasesArchive of Old Cases

Case No : 1400 Date 2024-08-19

  • Courtesy of Kum Ju Chae / Jeonbuk National University Hospital
  • Age/Sex 64 / F
  • Chief Complaint
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Diagnosis With Brief Discussion

Diagnosis
Amiodarone induced pulmonary toxicity
Radiologic Findings
CT scans show peripheral and lower-lobe predominant patchy consolidation and ground-glass opacity. Attenuation of liver is increased.
Brief Review
This patient had a history of atrial fibrillation and was treated with amiodarone. After discontinuation of amiodarone, chest radiograph showed improvement of diffuse increased opacity.
Amiodarone is an antiarrhythmic drug with a long half-life. Both amiodarone and its metabolites accumulate in high quantities in tissues and also interact with the phospholipid’s metabolism. These tissues are represented by adipose tissue and well-perfused organs: liver, lung, or skin tissue. Amiodarone is an iodine-containing compound; therefore, parenchymal lesions often show high attenuation, with a range from 82 to 174 H.
Amiodarone-induced pulmonary fibrosis can manifest in various forms, including diffuse alveolar damage, chronic interstitial pneumonia, organizing pneumonia, pulmonary hemorrhage, lung nodules, and pleural disease. The underlying pathological mechanism involves the accumulation of phospholipid complexes in histiocytes and type II pneumocytes within the lungs. The most dramatic manifestation of amiodarone-induced alveolitis is rapidly progressive diffuse pneumonitis with acute respiratory failure and ARDS-like changes.
The first therapeutic measure that is required is to stop the administration of amiodarone. In patients with respiratory failure or significant lung damage, the administration of systemic corticosteroids is indicated. Even after administration of this type of treatment, pulmonary recovery, both imaging and functional, is not completely reversible
References
1. Budin CE, Cocuz IG, Sabău AH, Niculescu R, Ianosi IR, Ioan V, Cotoi OS. Pulmonary Fibrosis Related to Amiodarone-Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review. Diagnostics (Basel). 2022 Dec 19;12(12):3217.
2. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 2000;20(5):1245-1259. doi:10.1148/radiographics.20.5.g00se081245
3. Samantha J. Ellis, Joanne R. Cleverley, and Nestor L. Müller. Drug-Induced Lung Disease: High-Resolution CT Findings. American Journal of Roentgenology. 2000 Oct;175(4):1019-24.
Keywords

No. of Applicants : 67

▶ Correct Answer : 38/67,  56.7%
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Other , Korea (South) SEONGSU KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
  • - Other , Korea (South) SEOL A LEE
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Kyoto University , Japan SHO KOYASU
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - GHICL , France MANUEL TOLEDANO
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Oita university , Japan AYUMI KAMEI
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Osaka University , Japan AKINORI HATA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan YOSHIKI ISHII
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - , Korea (South) DONG-HO BANG
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
▶ Semi-Correct Answer : 4/67,  6.0%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - TB centre kasaragod. , India rikhy krishnan
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
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