Medication-induced Pulmonary Injury: A Scenario- and Pattern-based Approach to a Perplexing Problem

Area of Science:

• Pulmonary Medicine
• Radiology
• Pharmacology

Background:

• Medication-induced pulmonary injury (MIPI) is an increasingly common yet difficult-to-diagnose condition.
• Diagnosis is often hindered by the lack of specific diagnostic tests.

Purpose of the Study:

• To aid the diagnosis of MIPI by correlating common imaging patterns with specific medications used in various clinical settings.
• To improve the differential diagnosis of acquired lung disease in patients exposed to certain medications.

Main Methods:

• Review and description of six common MIPI imaging patterns: sarcoidosis-like, diffuse ground-glass opacities, organizing pneumonia, centrilobular ground-glass nodules, linear-septal, and fibrotic.
• Discussion of these patterns within five clinical scenarios (rheumatology/GI, cardiology, hematology, oncology, inpatient) and associated medications.
• Comparison of MIPI imaging findings with alternative lung diseases in each clinical context.

Main Results:

• Six characteristic imaging patterns of MIPI are identified.
• These patterns are linked to specific drug classes used in distinct clinical specialties.
• Differential diagnoses, such as connective tissue disease-related ILD and hydrostatic pulmonary edema, are considered.

Conclusions:

• Awareness of MIPI imaging patterns and associated medications can facilitate its inclusion in the differential diagnosis.
• A definitive diagnosis of MIPI often relies on multidisciplinary consensus due to the absence of specific tests.