Salinas F V, Winterbauer R H
Department of Pulmonary Critical Care Medicine, Virginia Mason Medical Center, Seattle, WA 98111, USA.
Semin Respir Infect. 1995 Sep;10(3):143-53.
The onset of fever and pulmonary infiltrates in patients who have been treated with thoracic irradiation is a relatively common occurrence. Radiation pneumonitis and infectious pneumonitis share many clinical features. The major objective of the clinician in evaluating patients who present with a febrile pneumonitis syndrome is to establish the correct diagnosis with as much certainty as possible. This article will review the pathogenesis, histopathology, and clinical features of radiation pneumonitis. Certain clinical and radiographic aspects of radiation pneumonitis will help the clinician arrive at the correct diagnosis. The patient with radiation pneumonitis will present with an insidious onset of dyspnea, fever, and nonproductive cough. Review of the chest radiograph at presentation and all chest radiographs since the completion of radiation therapy will provide the key to the clinical diagnosis of radiation pneumonitis. The infiltrate characteristically has a sharp margin that conforms to the port of irradiation. If the chest radiograph is not characteristic, it will be necessary to rule out infection. If noninvasive studies are nondiagnostic, then bronchoscopy may be necessary to exclude potential infectious agents.
接受胸部放疗的患者出现发热和肺部浸润是比较常见的情况。放射性肺炎和感染性肺炎有许多共同的临床特征。临床医生在评估出现发热性肺炎综合征的患者时，主要目标是尽可能确定地做出正确诊断。本文将综述放射性肺炎的发病机制、组织病理学和临床特征。放射性肺炎的某些临床和影像学表现将有助于临床医生做出正确诊断。放射性肺炎患者会隐匿起病，出现呼吸困难、发热和干咳。回顾就诊时的胸部X线片以及放疗结束后的所有胸部X线片，将为放射性肺炎的临床诊断提供关键线索。浸润灶的边缘通常清晰，与照射野相符。如果胸部X线片不典型，则有必要排除感染。如果无创检查无法确诊，那么可能需要进行支气管镜检查以排除潜在的感染源。
