Pulmonary drug toxicity: Radiologic and pathologic manifestations

被引:267
作者
Rossi, SE
Erasmus, JJ
McAdams, HP
Sporn, TA
Goodman, PC
机构
[1] Duke Univ, Med Ctr, Dept Radiol, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Pathol, Durham, NC 27710 USA
[3] Fdn Dr Enrique Rossi, Dept Radiol, Buenos Aires, DF, Argentina
关键词
drugs; toxicity; lung; effects of drugs on; diseases; hemorrhage;
D O I
10.1148/radiographics.20.5.g00se081245
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Pulmonary drug toxicity is increasingly being diagnosed as a cause of acute and chronic lung disease. Numerous agents including cytotoxic and noncytotoxic drugs have the potential to cause pulmonary toxicity. The clinical and radiologic manifestations of these drugs generally reflect the underlying histopathologic processes and include diffuse alveolar damage (DAD), nonspecific interstitial pneumonia (NSIP), bronchiolitis obliterans organizing pneumonia (BOOP), eosinophilic obliterative bronchiolitis, pulmonary hemorrhage, edema, pneumonia, hypertension, or veno-occlusive disease. DAD is a common manifestation of pulmonary drug toxicity and is frequently caused by cytotoxic drugs, especially cyclophosphamide, bleomycin, and carmustine. It manifests radiographically as bilateral hetero- or homogeneous opacities usually in the mid and lower lungs and on high-resolution computed tomographic (CT) scans as scattered or diffuse areas of ground-glass opacity. NSIP occurs most commonly as a manifestation of carmustine toxicity or of toxicity from noncytotoxic drugs such as amidarone. At radiography, it appears as diffuse areas of heterogeneous opacity, whereas early CT scans show diffuse ground-glass opacity and late CT scans show fibrosis in a basal distribution. BOOP, which is commonly caused by bleomycin and cyclophosphamide (as well as gold salts and methotrexate), appears on radiographs as hetero- and homogeneous peripheral opacities in both upper and lower lobes and on CT scans as poorly defined nodular consolidation, centrilobular nodules, and bronchial dilatation. Knowledge of these manifestations and of the drugs most frequently involved can facilitate diagnosis and institution of appropriate treatment.
引用
收藏
页码:1245 / 1259
页数:15
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