Immunotherapy-induced pulmonary toxicity: A comprehensive radiological review

The expanding clinical application of immune checkpoint inhibitors (ICIs) across oncologic therapeutics has revealed a spectrum of pulmonary toxicities, with reported incidence rates ranging from 2 % to 19 % depending on the therapeutic regimen. Computed tomography (CT) imaging is the cornerstone for diagnostic evaluation, reliably identifying characteristic radiographic patterns such as organizing pneumonia, hypersensitivity pneumonitis-like reactions, and diffuse alveolar damage. The diagnostic challenge lies in distinguishing these immune-mediated pulmonary injuries from infectious etiologies, radiation-induced lung injury, and neoplastic progression, each requiring distinct therapeutic interventions. Contemporary management protocols employ glucocorticoid therapy dosed according to toxicity severity, while investigational approaches explore targeted immunomodulators. This review synthesizes current evidence regarding radiographic manifestations, diagnostic pathways, and therapeutic algorithms, offering radiologists a structured approach to evaluating ICI-associated pulmonary complications. We highlight recent advances, including quantitative CT analysis and serum biomarkers, that promise to refine early detection and risk stratification.