대한흉부영상의학회 Korean Society of Thoracic Radiology

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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
  • Figure 1
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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%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Other , Korea (South) SEOL A LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 4/67,  6.0%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - TB centre kasaragod. , India rikhy krishnan
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