Pulmonary drug toxicity: radiologic and pathologic manifestations

Area of Science:

• Pulmonology
• Toxicology
• Radiology

Background:

• Pulmonary drug toxicity is a growing cause of acute and chronic lung disease.
• Various cytotoxic and noncytotoxic agents can induce lung damage.
• Clinical and radiologic findings often correlate with specific histopathologic changes.

Purpose of the Study:

• To outline the clinical and radiologic manifestations of pulmonary drug toxicity.
• To associate specific drug classes with distinct histopathologic patterns.
• To aid in the diagnosis and management of drug-induced lung injury.

Main Methods:

• Review of clinical presentations and radiologic findings associated with pulmonary drug toxicity.
• Correlation of imaging findings (radiography and CT) with histopathologic processes.
• Identification of commonly implicated drugs for each toxicity pattern.

Main Results:

• Diffuse alveolar damage (DAD) is common, often from cytotoxic drugs (cyclophosphamide, bleomycin, carmustine), presenting as bilateral opacities on radiography and ground-glass opacity on CT.
• Nonspecific interstitial pneumonia (NSIP) is linked to carmustine or amiodarone, showing diffuse opacity on radiography and ground-glass opacity progressing to fibrosis on CT.
• Bronchiolitis obliterans organizing pneumonia (BOOP) is associated with bleomycin, cyclophosphamide, gold salts, and methotrexate, appearing as peripheral opacities on radiography and nodules/consolidation on CT.

Conclusions:

• Pulmonary drug toxicity presents with diverse radiologic patterns mirroring histopathology.
• Specific patterns like DAD, NSIP, and BOOP are frequently linked to particular drugs.
• Understanding these drug-induced lung disease manifestations is crucial for timely diagnosis and treatment.