Jochelson M S, Tarbell N J, Weinstein H J
J Clin Oncol. 1986 Jun;4(6):874-82. doi: 10.1200/JCO.1986.4.6.874.
Mantle irradiation is often part of the treatment for Hodgkin's disease. Localized pneumonitis and fibrosis are well-known sequelae of this treatment. We report nine patients with unusual thoracic radiographic findings following treatment for Hodgkin's disease. All nine had mediastinal widening. Seven of these patients received combined modality therapy in which prednisone was given with their MOPP. In these seven patients, an increase in mediastinal width developed at the same time as the radiographic changes of radiation pneumonitis. Two patients developed bilateral infiltrates extending beyond the field of radiation to the lung periphery. In one of these patients, a spontaneous pneumomediastinum developed. One patient underwent mediastinal biopsy that revealed inflammatory changes similar to those seen in radiation pneumonitis. All patients either responded to steroids or had spontaneous regression of radiographic abnormalities supporting the presumed diagnosis of treatment related changes. Recognition of these unusual sequelae of mantle irradiation will aid in differentiating them from infection or tumor and lead to prompt, appropriate treatment.
斗篷野照射常常是霍奇金病治疗的一部分。局部肺炎和纤维化是这种治疗众所周知的后遗症。我们报告了9例霍奇金病治疗后出现不寻常胸部X线表现的患者。所有9例均有纵隔增宽。其中7例接受了联合化疗，在MOPP方案基础上加用了泼尼松。在这7例患者中，纵隔宽度增加与放射性肺炎的X线改变同时出现。2例患者出现双侧浸润，超出了肺部放疗野范围，累及肺周边。其中1例患者发生了自发性纵隔气肿。1例患者接受了纵隔活检，显示出与放射性肺炎相似的炎症改变。所有患者对类固醇治疗均有反应或影像学异常自发消退，支持了与治疗相关改变的推测诊断。认识到斗篷野照射这些不寻常的后遗症将有助于将它们与感染或肿瘤相鉴别，并促使进行及时、恰当的治疗。
