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Radiation therapy (early effects)

To the chest. Changes are usually ipsilateral to the irradiated side except in acute radiation pneumoniitis and in radiation-elicited BOOP

Last update : 05/09/2018

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.v Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

I.ab Radiation-induced lung injury (RILI)

I.ac Acute radiation pneumonitis

II.b ARDS - Acute lung injury

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.h Chylothorax

VIII.c Upper airway obstruction other than angioedema or hematoma

IX.h Dyspnea, unexplained otherwise

XII.k Constrictive pericarditis - Pericardial thickening

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.d Path: Acute fibrinous organizing pneumonia (AFOP-pattern) (see also If)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.h Path: NSIP-fibrotic pattern

XVI.bl Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan

XIX.a BAL: An excess proportion of lymphocytes

XIX.c BAL: An excess proportion of eosinophils

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France