Drug-induced lung disease: high-resolution CT and histological findings.
OBJECTIVE
To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT.


METHODS
Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction.


RESULTS
On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD.


CONCLUSIONS
In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis.
Cleverley
Joanne R
JR
Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Screaton
Nicholas J
NJ
Hiorns
Melanie P
MP
Flint
Julia D A
JD
Müller
Nestor L
NL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D000970:Antineoplastic Agents