Drug-induced Lung Disease: High-resolution CT and Histological Findings

• Published in: Clinical radiology 2002-04, Vol.57 (4), p.292-299
• Main Authors: Cleverley, Joanne R., Screaton, Nicholas J., Hiorns, Melanie P., Flint, Julia D.A., Müller, Nestor L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Biological and medical sciences; Drug toxicity and drugs side effects treatment; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Lung Diseases - chemically induced; Lung Diseases - diagnostic imaging; Lung Diseases - pathology; Lung Diseases, Interstitial - chemically induced; Lung Diseases, Interstitial - diagnostic imaging; lung, CT, high resolution CT, drug-induced lung disease; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumonia - chemically induced; Pneumonia - diagnostic imaging; Pneumonia - pathology; Retrospective Studies; Tomography, X-Ray Computed - methods; Toxicity: respiratory system, ent, stomatology
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1053/crad.2001.0792

AIM: To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. MATERIALS AND METHODS: Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. RESULTS: On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n=17), consolidation (n=14), interlobular septal thickening (n=15) and centrilobular nodules (n=8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. CONCLUSION: In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis. Cleverly, J. R. et al. (2002) Clinical Radiology57, 292–299.