Rossi S E, Erasmus J J, McAdams H P, Sporn T A, Goodman P C
Department of Radiology, Duke University Medical Center, Erwin Rd, Durham, NC 27710, USA.
Radiographics. 2000 Sep-Oct;20(5):1245-59. doi: 10.1148/radiographics.20.5.g00se081245.
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 pneumonia, obliterative bronchiolitis, pulmonary hemorrhage, edema, 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.
肺药物毒性越来越多地被诊断为急慢性肺部疾病的病因。包括细胞毒性和非细胞毒性药物在内的众多药物都有可能导致肺毒性。这些药物的临床和影像学表现通常反映了潜在的组织病理学过程，包括弥漫性肺泡损伤（DAD）、非特异性间质性肺炎（NSIP）、闭塞性细支气管炎伴机化性肺炎（BOOP）、嗜酸性肺炎、闭塞性细支气管炎、肺出血、水肿、高血压或静脉闭塞性疾病。DAD是肺药物毒性的常见表现，常由细胞毒性药物引起，尤其是环磷酰胺、博来霉素和卡莫司汀。其影像学表现为双侧异质性或均匀性模糊影，通常位于中下部肺野，在高分辨率计算机断层扫描（CT）上表现为散在或弥漫性磨玻璃样模糊影。NSIP最常见于卡莫司汀毒性或胺碘酮等非细胞毒性药物的毒性表现。在X线摄影中，它表现为弥漫性异质性模糊影，而早期CT扫描显示弥漫性磨玻璃样模糊影，晚期CT扫描显示基底分布的纤维化。BOOP通常由博来霉素和环磷酰胺（以及金盐和甲氨蝶呤）引起，在X线片上表现为上下叶的异质性和均匀性周边模糊影，在CT扫描上表现为边界不清的结节状实变、小叶中心结节和支气管扩张。了解这些表现以及最常涉及的药物有助于诊断并采取适当的治疗措施。
