Pneumotox » Drug » Radiation therapy (medium term & late effects)

Radiation therapy (medium term & late effects)

5

Review at PMID 27261350. Radiation therapy and the heart: PMID 7754953

Last update : 27/10/2018

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

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

4

I.g Pulmonary fibrosis

5

I.h Subclinical pulmonary infiltrates/ILD

4

I.o Focal/localized area of pneumonitis/fibrosis

5

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

3

I.x Pleuroparenchymal fibroelastosis (PPFE)

2

II.b ARDS - Acute lung injury

2

III.c Hemoptysis

2

IV.h Large airway necrosis

2

IV.k Bronchiectasis

3

IV.m Bronchial stenosis/stricture

3

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

3

V.b Eosinophilic pleural effusion

1

V.c Pleural thickening

4

V.f Pneumothorax

2

V.h Chylothorax

2

V.l Malignant pleural mesothelioma

2

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

2

V.t The apical cap

5

VI.c Pulmonary veno-occlusive disease

1

VI.t Pulmonary artery aneurysm(s)

1

VI.ab Pulmonary artery stenosis

1

VII.d Fibrosing mediastinitis

3

VII.i Mediastinitis

2

VII.j Compression of mediastinal structures/organs

2

VII.l Calcification of mediastinal lymph nodes

1

VIII.c Upper airway obstruction other than angioedema or hematoma

1

VIII.j Laryngeal disorder-Laryngeal nerve palsy (dysphonia, hoarseness)

1

VIII.r Tracheal/large airway necrosis, chondronecrosis, perforation

2

VIII.t Vocal cord paresis/paralysis

1

VIII.ab Airway (e.g. tracheoesophageal) fistula

1

IX.a Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

2

IX.aj Paraspinal muscle myositis/myopathy/neuromyopathy +- the dropped head syndrome

2

XI.g Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

2

XI.h Esophageal pathology (erosion, ulcer, tear, rupture, fistula)

1

XI.i Esophageal toxicity

4

XI.p Chest deformity: platythorax

3

XI.v Rib fracture

2

XI.ag Vertebral compression fracture

1

XI.ax Esophageal stenosis/stricture

2

XI.bb Aorto-esophageal fistula

1

XI.bs Dropped-head syndrome

2

XII.a Left or biventricular dysfunction/failure

3

XII.b Valvular heart disease and/or dysfunction

3

XII.f Cardiomyopathy (acute, subacute, chronic)

3

XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

2

XII.k Constrictive pericarditis - Pericardial thickening

2

XII.o Coronary artery disease (subacute, chronic)

2

XII.s Heart block (bundle branch- or AV-)

1

XII.ad Effusive-constrictive pericarditis

1

XII.ak Late left ventricular dysfunction/failure

3

XII.an Pericardial calcification

1

XII.bc Coarctation of the aorta (acquired)

1

XIII.a Lung cancer

2

XIII.d Malignant mesothelioma (pleural, pericardial)

2

XIII.e Breast cancer

2

XIII.j Pulmonary synovial sarcoma

1

XIII.l Chondrosarcoma

1

XIII.m Tumor of the heart

1

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

1

XV.l Path: Pulmonary fibrosis (not otherwise specified or unclassifiable)

5

XVI.ab Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

2

XVI.bi Imaging: Hyperlucent lung

1

XVI.bj Imaging: Atelectasis (a combination of increased density and volume loss. Typically lobar)

2

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

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

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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