Post treatment

Question 1

Radiation induced Disease

Answer 1

Pathology:

• Gross: Radiation fibrosis with extensive scar formation
• Micro:
  
  • RAdiation pneumonitis: injury to small vessels –> increased permiability –> infiltration of inflammatory cells and filling of alveolar space
  • Radiation Fibrosis: fibroblast proliferation, septal thickening, vascular sclerosis

CT:

• Shrinkage of mass/LN
• Radiation pneumonitis: 1-6 months
  
  • GGO +/- consolidation
  • +/- pleural effusion
• Radiation Fibrosis >6 months
  
  • Conslidation with progressive volume loss, architectural distoriton and traction bronchiectasis
  • Stabilises after 1-2 years
  • Consolidation can be mss like
  • +/- pleural effusion/thickening
  • Organizin pneumonia
• Mediastinum:
  
  • Calcified LN (esp lymphoma), fibrosis
  • Esophagitis
  • Fistulas
  • Pericarditis +/- thickening/calcification long term
• Bones: osteonecrosis, radiation induced sarcoma

Question 2

Drug induced lung disease

Answer 2

Lung disease described with numerous drugs: cytotoxic/cytostatic and targeted therapy

Lung abnormalities: WIDE RANGE

• Diffuse alveolar damage (ARDS)
• Interstitial fibrosis (UIP/NSIP)
• Hypersensitivity pneumonitis
• Eosinophilic pneumonia
• Organizing pneumonia
• Pulmonary oedema
• Diffuse alveolar hemorrhage
• Vasculitis
• Pleural abnormalties:
  
  • SLE syndrome: pleuropericadial effusion
  • Fibrosis
  • Air leak
• Vascular abnormalities:
  
  • VTE
  • PAH

Question 3

Amiodarone Toxicity

Answer 3

Pathology:

• Iodinated benzofuran derivative used to treat cardiac arrhythmias
• Lung damage by amiodarone and its metabolites: direct cytotoxic effects
• Immunologic reaction: OP, NSIP, DAD, DAH(rare)
• Micro: chronic inflamamtion/fibrosis of alveolar septa

Imaging:

• HIgh attenuation foci in lung 70%
• Consolidation: peripheral, peribronchial, perilobular, upper lobe predominant
• GGO: basal or diffuse
• Reticulations: peripheral and basal predoinant
• Pleural effusions 50%
• Fibrosis: NSIP type pattern