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Congress: ECR24
Poster Number: C-22143
Type: EPOS Radiologist (educational)
DOI: 10.26044/ecr2024/C-22143
Authorblock: C. B. Monti1, M. T. A. T. Wetscherek2, T. Sadler2, S. Karia2, A. P. Barker2, M. Kotnik2, J. Babar2; 1Milan/IT, 2Cambridge/UK
Disclosures:
Caterina Beatrice Monti: Nothing to disclose
Maria Teodora Antuaneta TA Wetscherek: Nothing to disclose
Timothy Sadler: Nothing to disclose
Sumit Karia: Nothing to disclose
Allanah Paula Barker: Nothing to disclose
MaruĊĦa Kotnik: Nothing to disclose
Judith Babar: Nothing to disclose
Keywords: Lung, CT, Complications, Diagnostic procedure, Treatment effects, Toxicity
Learning objectives Drug-induced interstitial lung disease (DILD) is difficult to diagnose and occurs due to various mechanisms of lung injury from certain drugs. Due to the non-specific nature of both symptoms and imaging findings and the lack of clinical information often provided by clinicians it is important that radiologists have an awareness of the commoner medications that can cause DILD and the CT appearances that can be encountered.  Thus, the aim of this educational exhibit is to provide general radiologists with an...
Read more Background The incidence of DILD is on the rise, especially with the introduction of new targeted drugs which may yield pulmonary side effects, and it is now estimated to be around 12 cases per million individuals/year. The main drugs related to DILD listed according to prevalence are chemotherapeutic or immunotherapeutic agents, anti-inflammatory medications, cardiovascular agents, and antibiotics. DILD can have an acute and severe, or chronic and more insidious presentation of symptoms which are often non-specific. The main pathological patterns are...
Read more Findings and procedure details Patients with DILD may be observed in several different clinical settings, the most common being rheumatology and gastroenterology, cardiology, and general practice. Cardiology Concerning cardiovascular agents, amiodarone is the main cause of lung toxicity, followed by other antiarrhythmics, anticoagulants and antihypertensives. Amiodarone (Fig.2 and 3) The main pattern of pulmonary toxicity from amiodarone is OP, but other possible manifestations may include eosinophilic pneumonia, hypersensitivity pneumonia or fibrotic patterns. Amiodarone toxicity has been linked to risk factors such as increasing age, dose and presence...
Read more Conclusion Given the prevalence of DILD, such a condition should always be considered when compatible with the clinical presentation and history for a patient presenting with respiratory symptoms. General radiologists should be familiar with the main drugs and imaging patterns related to DILD, to ensure a prompt recognition of this pathologic entity so appropriate treatment and withholding of drugs can avoid chronic lung damage. The final diagnosis of DILD is one of exclusion, which often relies on a multidisciplinary consensus.
Read more References Schwaiblmair M (2012) Drug Induced Interstitial Lung Disease. Open Respir Med J 6:63–74. doi:10.2174/1874306401206010063. Spagnolo P, Bonniaud P, Rossi G, Sverzellati N, Cottin V (2022) Drug-induced interstitial lung disease. Eur Respir J 60:2102776. doi:10.1183/13993003.02776-2021. Sridhar S, Kanne JP, Henry TS, Revels JW, Gotway MB, Ketai LH (2022) Medication-induced Pulmonary Injury: A Scenario- and Pattern-based Approach to a Perplexing Problem. RadioGraphics 42:38–55. doi:10.1148/rg.210146. Kim J-W, Chung SW, Pyo JY et al (2023) Methotrexate, leflunomide and tacrolimus use and the progression of rheumatoid arthritis-associated interstitial...
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