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Joseph Junewick, MD FACR
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Radiation Pneumonitis

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
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Modality/Study Types: CT NM
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History

16 year old with history of relapsed stage IV-A Hodgkin disease. Prior pulmonary involvement was irradiated.


Case Images


Diagnosis

Radiation Pneumonitis

Clinical Notes

Pathology – Bronchiolitis obliterans organizing pneumonia and sclerosing vasculitis, consistent with radiation pneumonitis.

Findings

CT – Bilateral patchy bronchocentric and left subpleural pulmonary parenchymal opacifications.

PET – Maximum intensity projection 3D and axial filtered back projection FDG images demonstrate marked avidity corresponding to the CT disease.

Discussion

Bronchiolitis obliterans organizing pneumonia (BOOP) has many etiologies including connective tissue disease, drug reaction, infection, aspiration and radiation therapy. Pathologically, BOOP has a patchy distribution within the secondary lobules. Plugs of fibroblastic connective tissue are present in the respiratory bronchioles and alveolar ducts. Proteinaceous fluid and fibroblastic tissue fill the alveoli with a variable degree of chronic inflammatory cells. Patients are often symptomatic for months prior to diagnosis with cough, fever, dyspnea, sputum production and weight loss.

Radiographically BOOP manifests as one of four patterns: 1) multiple usually bilateral and symmetric patchy opacities, 2) diffuse bilateral interstitial opacities, 3) focal consolidations, or 4) multiple nodules or confluent opacities. None of these patterns are specific and can be seen in chronic eosinophilic pneumonia, lymphoma, alveolar proteinosis, and hemorrhage.

Radiation induced lung disease represents a spectrum of abnormalities which varies depending upon the time from last irradiation, volume of lung irradiated, and the dose and fractionation. An acute transient pneumonitis develops 4-12 weeks after completion of radiation therapy whereas radiation fibrosis usually develops 6-12 months after completion and can progress for upto 2 years. Certain chemotherapy agents (e.g., actinomycin D, adriamycin, bleomycin and busulfan) can potentiate lung damage from irradiation.

Reference

Choi YW, et al. Effects of radiation therapy on the lung: Radiologic appearances and differential diagnosis. Radiographics (2004); 24:985-998.

Shin L, Katz DS, Yung E. Hypermetabolism of F-18 FDG PET of multiple pulmonary nodules resulting from bronchiolitis obliterans organizing pneumonia. Clin Nuc Med (2004); 29(10):654-656.



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