Bronchoalveolar lavage cellular analysis and gallium lung scan in the assessment of patients with amiodarone-induced pneumonitis.
Seven patients suffering from amiodarone-induced pneumonitis were followed after diagnosis over a period of 16 +/- 6 months. All of them showed clinical, radiographic and functional manifestations of interstitial lung disease. Bronchoalveolar lavage was performed on 6 of them and disclosed lymphocytosis in 2 cases (associated to eosinophilia in 1 of them), neutrophilia in 1 and normal differential count in 2. In 1 case there were abundant hemosiderin-laden macrophages. In addition, all patients evidenced an increased 67Ga lung scan uptake. After discontinuation of amiodarone therapy (with or without corticosteroid therapy), 67Ga lung uptake normalized in 3 cases, but remained increased in 3. Bronchoalveolar lavage was repeated only in 2 cases, showing disappearance of lymphocytosis in one and abundant hemosiderin-laden macrophages in the other. Our results suggest that (1) hemosiderin-laden macrophages can be found in bronchoalveolar lavage in patients with amiodarone-induced pneumonitis, probably related to subclinical chronic left-sided heart failure; (2) 67Ga lung scan appears to be a sensitive marker of amiodarone pneumonitis, although it can remain abnormal after pulmonary clinical, radiographic and functional normalization.
Department of Medicine (Servei de Pneumologia), Hospital Clinic, Facultat de Medicina, Universitat de Barcelona, Spain.
A
A
Xaubet
J
J
Roca
R
R
Rodriguez-Roisin
J
J
Herranz
A
A
Marin
F
F
Lomeña
J M
JM
Montserrat
A
A
Agustí-Vidal
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D003327:Coronary Disease / Q000188:drug therapy*; D005500:Follow-Up Studies; D005710:Gallium Radioisotopes; D006801:Humans; D008168:Lung / Q000473:pathology; D008176:Lung Volume Measurements; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000139:chemically induced* / Q000473:pathology
D005710:Gallium Radioisotopes; D000638:Amiodarone