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.
Xaubet
A
A
Department of Medicine (Servei de Pneumologia), Hospital Clinic, Facultat de Medicina, Universitat de Barcelona, Spain.
Roca
J
J
Rodriguez-Roisin
R
R
Herranz
J
J
Marin
A
A
Lomeña
F
F
Montserrat
J M
JM
Agustí-Vidal
A
A
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