Polverosi R, Zanellato E, Doroldi C
Servizio di Radiologia, Ospedale di Montebelluna (TV).
Radiol Med. 1996 Jul-Aug;92(1-2):58-62.
To assess the radiographic patterns of amiodarone-induced pulmonary toxicity, the chest films (32) and HRCT scans (16) were reviewed of 14 patients into amiodarone protocols for 3 months to 6.5 years (average: 40.5 months). All patients were symptomatic and presented with shortness of breath, a general malaise, a fever. The radiographic findings included: intersurface signs, defined as irregular interfaces between parenchyma, bronchi, vessels and visceral pleura, indicating interstitial abnormalities (HRCT: 8 = 50%); septal thickening (Kerley's lines) (chest film: 32 = 100%; HRCT: 6 = 37%); reticular opacities (chest film: 24 = 75%; HRCT: 6 = 37%); peribronchial cuffing (chest film: 2 = 6%; HRCT: 0); interstitial nodules (chest film: 12 = 37%; HRCT: 4 = 25%); alveolar nodules (chest film: 16 = 50%; HRCT: 12 = 75%); consolidations (chest film: 20 = 62%; HRCT: 12 = 75%); parenchymal masses (chest film: 2 = 6%; HRCT: 2 = 12%); fibrosis (chest film: 24 = 75%; HRCT: 16 = 100%); reduced lung volume (chest film: 14 = 43%; HRCT: 4 = 25%); pleural effusion and/or thickening (chest film: 4 = 12%; HRCT: 4 = 25%). The lesions were always localized in the lower lobes and often also in the upper lobes (chest film: 12 = 37%; HRCT: 14 = 87%); in the latter site the lesions were smaller. HRCT showed the peripheral site of the lesions. Amiodarone discontinuation and corticosteroids administration improved the radiographic patterns in 2 patients and attenuated the symptoms, with disappearance of alveolar nodules, in 11 patients. In contrast, clinical symptoms progressed and the radiographic pattern worsened in one patient. Both chest films (Kerley's lines, reticular, interstitial and alveolar opacities without cuffing and pleural effusion or clear fibrosis) and HRCT (fibrosis associated with alveolar opacities) showed sufficiently typical patterns of amiodarone-induced pulmonary toxicity, especially when associated with pleural thickening.
为评估胺碘酮所致肺毒性的影像学表现，回顾了14例接受胺碘酮治疗3个月至6.5年（平均40.5个月）患者的胸部X线片（32例）和高分辨率CT扫描（HRCT，16例）。所有患者均有症状，表现为气短、全身不适、发热。影像学表现包括：界面征，定义为实质、支气管、血管与脏层胸膜之间的不规则界面，提示间质异常（HRCT：8例，占50%）；间隔增厚（Kerley线）（胸部X线片：32例，占100%；HRCT：6例，占37%）；网状阴影（胸部X线片：24例，占75%；HRCT：6例，占37%）；支气管袖口征（胸部X线片：2例，占6%；HRCT：0例）；间质结节（胸部X线片：12例，占37%；HRCT：4例，占25%）；肺泡结节（胸部X线片：16例，占50%；HRCT：12例，占75%）；实变（胸部X线片：20例，占62%；HRCT：12例，占75%）；实质肿块（胸部X线片：2例，占6%；HRCT：2例，占12%）；纤维化（胸部X线片：24例，占75%；HRCT：16例，占100%）；肺容积减小（胸部X线片：14例，占43%；HRCT：4例，占25%）；胸腔积液和/或胸膜增厚（胸部X线片：4例，占12%；HRCT：4例，占25%）。病变总是位于下叶，也常位于上叶（胸部X线片：12例，占37%；HRCT：14例，占87%）；在上叶部位病变较小。HRCT显示病变位于外周。停用胺碘酮并给予皮质类固醇治疗后，2例患者的影像学表现改善，11例患者症状减轻，肺泡结节消失。相反，1例患者临床症状进展，影像学表现恶化。胸部X线片（Kerley线、无袖口征及胸腔积液或明确纤维化的网状、间质和肺泡阴影）和HRCT（与肺泡阴影相关的纤维化）均显示出足够典型的胺碘酮所致肺毒性表现，尤其是合并胸膜增厚时。
