Radionuclide scanning in the detection of drug-induced lung disorders

Drug-induced pulmonary toxicity commonly results in interstitial lung disease characterized by the presence of inflammatory cells in pulmonary parenchyma. Gallium-67 citrate lung scintigraphy is currently the most sensitive test for the detection of inflammatory lesions in the lungs. Although chest radiographs often detect interstitial lung disease, they may be normal during the early alveolitis stage, when gallium scans are positive. Therefore, gallium scans can be utilized for the early diagnosis of drug-induced pulmonary reactions, leading to withdrawal of the drug and preventing the irreversible and potentially serious complication of pulmonary insufficiency. Gallium scintigraphy can also be used to follow these patients because it reflects the inflammatory changes in the lungs. This article presents a survey of the literature on gallium-67 scintigraphy in drug-related pulmonary inflammation. Gallium scans have been reported as abnormal in pulmonary toxicity caused by amiodarone, busulfan, bleomycin, procarbazine, nitrofurantoin, pentazocine, cephalosporin, cyclophosphamide, and cocaine, even in the absence of radiographic findings. The role of gallium scintigraphy in the early detection of pulmonary toxicity is emphasized.