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Weekly Chest CasesCases by Disease Category

Case No : 1240 Date 2021-07-27

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  • Courtesy of Hee Kang / Kosin University Gospel Hospital
  • Age/Sex 73 / M
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Amiodarone-induced pulmonary toxicity
Radiologic Findings
Fig. 1. Chest radiograph showing diffusely increased interstitial markings and ground-glass opacities (GGOs) in the left lung and right middle lung zones.
Figs. 2
Brief Review
Amiodarone is an iodinated benzofuran derivative used to suppress ventricular and supraventricular tachyarrhythmias. Pulmonary toxicity is one of the most serious adverse effects of amiodarone. Several forms of pulmonary disease occur among patients treated with amiodarone, including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules and solitary masses, and pleural effusion. Other adverse effects of amiodarone include photosensitivity, blue-gray discoloration of the skin, thyroid dysfunction, corneal deposits, liver dysfunction, and bone marrow suppression.
Interstitial pneumonitis is the most common presentation of amiodarone-induced pulmonary disease. Interstitial pneumonitis usually presents after 2 months of therapy, especially in patients whose amiodarone dose exceeds 400 mg/day.
On chest radiography, interstitial pneumonitis due to amiodarone typically shows new, diffuse or localized, reticular, ground-glass, or mixed opacities. These changes may be migratory and can occur in the absence of symptoms. Pleural effusion is rare.
The computed tomography (CT) images of patients with amiodarone-induced interstitial pneumonitis may show areas of high attenuation in the lungs, liver, and spleen owing to the accumulation of iodinated amiodarone in tissue macrophages. Although this finding is specific to amiodarone use, it is not necessary for the diagnosis of amiodarone pneumonitis and may be seen in the absence of lung toxicity. Other high-resolution CT findings related to amiodarone-induced interstitial pneumonitis include diffuse (usually bilateral) ground-glass opacities and septal thickening. Honeycombing and traction bronchiectasis can also be seen.
The treatment of amiodarone-induced interstitial pneumonitis primarily consists of stopping amiodarone and, in more symptomatic patients, initiating systemic glucocorticoids. Owing to the accumulation of amiodarone in fatty tissues and its long elimination half-life (approximately 45 days), pulmonary toxicity may initially progress despite drug discontinuation.
Amiodarone is not recommended in patients who have recovered from amiodarone-induced pulmonary toxicity because of the risk of recurrent disease and progressive pulmonary fibrosis.
Please refer to
Case 1054, Case 704, Case 593, Case 330, Case 176, Case 114,
References
N Wolkove, m Baltzan. Amiodarone pulmonary toxicity. Can respir J 2009;16(2):43
Edward D Chan, Talmadge E King Jr, Amiodaron pulmonary toxicity. https://www.uptodate.com/contents/amiodarone-pulmonary-toxicity
Keywords

No. of Applicants : 103

▶ Correct Answer : 69/103,  67.0%
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Other , Korea (South) HYEJIN YANG
  • - , Korea (South) HYEYOUNG CHOI
  • - , United Kingdom SAMSON KADE
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Canada ASHISH GUPTA
  • - Seoul Medical Center , Korea (South) WOONYOUNG BAEK
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Seoul National University Bundang Hospital , Korea (South) SOWON JANG
  • - , Italy PAOLO BALDASSARI
  • - , France CHARLES DAMIEN
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - , Korea (South) JIN YOUNG LEE
  • - , Korea (South) JUNG-IN JO
  • - , Brazil FERNANDO MORANDINI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - , Jordan HISHAM I KHATIB
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Other , Korea (South) KYOWON GU
  • - , Korea (South) EUNJIN LEE
  • - Other , Korea (South) MARI A
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - CHU Lille , France PAUL LEBERT
  • - GHICL , France MANUEL TOLEDANO
  • - Seoul Veterans Hospital , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Columbia asia hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Apollo Hospitals , India SHRUTHI P
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - , Korea (South) WONJU HONG
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - algeria , Algeria ZAKARIA CHERAGA
▶ Correct Answer as Differential Diagnosis : 1/103,  1.0%
  • - NIMS, HYDERABAD , India BHASKAR K
▶ Semi-Correct Answer : 4/103,  3.9%
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Japan KANAE TAKAHASHI
  • - Other , Korea (South) KYU-CHONG LEE
  • - National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
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