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Methotrexate-induced pulmonary injury: serial CT findings
Hiroaki Arakawa1, Masaomi Yamasaki, Yasuyuki Kurihara
1Department of Radiology, St. Marianna University School of Medicine, Kawasaki City, Japan.
Journal of Thoracic Imaging
|October 17, 2003
Summary
Computed tomographic (CT) findings in methotrexate (MTX)-induced pulmonary injury are variable, often presenting as diffuse opacities. Most cases improve with treatment, but pre-existing lung fibrosis may indicate a poorer prognosis.
Area of Science:
- Radiology
- Pulmonology
- Pharmacology
Background:
- Methotrexate (MTX) is a commonly used immunosuppressive drug.
- Pulmonary injury is a known, albeit rare, adverse effect of MTX therapy.
- Early identification of MTX-induced pulmonary injury is crucial for timely intervention.
Purpose of the Study:
- To describe the serial computed tomographic (CT) findings in patients with methotrexate (MTX)-induced pulmonary injury.
- To correlate CT features with clinical outcomes and treatment response.
Main Methods:
- Retrospective review of 8 patients with clinically diagnosed MTX-induced pulmonary injury.
- Evaluation of serial CT scans (admission and follow-up) for characteristic imaging features.
- Analysis of patient demographics, underlying conditions (rheumatoid arthritis, lupus), and treatment outcomes.
Main Results:
- Common CT findings included diffuse/patchy bilateral ground-glass opacities, reticulation, and consolidation.
- Opacities typically showed no specific lung zone predilection but could present with dependent or upper lobe predominance.
- Most opacities resolved quickly with treatment; however, 2 patients with pre-existing interstitial pneumonitis had refractory disease.
Conclusions:
- CT features of MTX-induced pulmonary injury are diverse, encompassing diffuse opacification, reticular patterns, and nodules.
- Prompt treatment generally leads to rapid improvement in CT findings.
- Patients presenting with lung fibrosis may have a less favorable prognosis, highlighting the importance of early diagnosis and management.