[Thoracic radiography and high resolution computerized tomography in the diagnosis of pulmonary disorders caused by amiodarone]

Abstract

To assess the radiographic patterns of amiodarone-induced pulmonary toxicity, the chest films (32) and HRCT scans (16) were reviewed of 14 patients into amiodarone protocols for 3 months to 6.5 years (average: 40.5 months). All patients were symptomatic and presented with shortness of breath, a general malaise, a fever. The radiographic findings included: intersurface signs, defined as irregular interfaces between parenchyma, bronchi, vessels and visceral pleura, indicating interstitial abnormalities (HRCT: 8 = 50%); septal thickening (Kerley's lines) (chest film: 32 = 100%; HRCT: 6 = 37%); reticular opacities (chest film: 24 = 75%; HRCT: 6 = 37%); peribronchial cuffing (chest film: 2 = 6%; HRCT: 0); interstitial nodules (chest film: 12 = 37%; HRCT: 4 = 25%); alveolar nodules (chest film: 16 = 50%; HRCT: 12 = 75%); consolidations (chest film: 20 = 62%; HRCT: 12 = 75%); parenchymal masses (chest film: 2 = 6%; HRCT: 2 = 12%); fibrosis (chest film: 24 = 75%; HRCT: 16 = 100%); reduced lung volume (chest film: 14 = 43%; HRCT: 4 = 25%); pleural effusion and/or thickening (chest film: 4 = 12%; HRCT: 4 = 25%). The lesions were always localized in the lower lobes and often also in the upper lobes (chest film: 12 = 37%; HRCT: 14 = 87%); in the latter site the lesions were smaller. HRCT showed the peripheral site of the lesions. Amiodarone discontinuation and corticosteroids administration improved the radiographic patterns in 2 patients and attenuated the symptoms, with disappearance of alveolar nodules, in 11 patients. In contrast, clinical symptoms progressed and the radiographic pattern worsened in one patient. Both chest films (Kerley's lines, reticular, interstitial and alveolar opacities without cuffing and pleural effusion or clear fibrosis) and HRCT (fibrosis associated with alveolar opacities) showed sufficiently typical patterns of amiodarone-induced pulmonary toxicity, especially when associated with pleural thickening.