Related Experiment Video
Updated: May 20, 2026
09:32
Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
Published on: December 9, 2021
[Atoll sign: A CT finding with clinical impact].
Marie Verstraeten1,2, Dieter Stevens1
1Universitair Ziekenhuis Gent, afd. Longziekten, Gent, België.
Nederlands Tijdschrift Voor Geneeskunde
|May 19, 2026
Summary
Pembrolizumab and bevacizumab treatment for metastatic cervical cancer can cause drug-induced organizing pneumonia. This condition, marked by the atoll sign on CT scans, resolved after discontinuing the therapy.
Area of Science:
- Oncology
- Pulmonology
- Radiology
Background:
- Metastatic cervical cancer requires aggressive treatment.
- Immune checkpoint inhibitors like pembrolizumab and anti-angiogenic agents like bevacizumab are standard therapies.
- Drug-induced lung injury is a known complication of cancer treatments.
Purpose of the Study:
- To report a case of drug-induced organizing pneumonia (DIOP) in a patient with metastatic cervical cancer.
- To highlight the characteristic "atoll sign" on chest CT in DIOP.
- To demonstrate the efficacy of treatment discontinuation.
Main Methods:
- Case report of a 48-year-old woman with metastatic cervical cancer.
- Treatment with pembrolizumab and bevacizumab.
- Diagnosis of DIOP based on clinical presentation and chest CT findings.
- Monitoring of radiological findings and pulmonary function after treatment cessation.
Main Results:
- The patient developed DIOP during treatment, characterized by the "atoll sign" (rounded ground-glass opacities with a peripheral consolidation ring) on chest CT.
- Discontinuation of pembrolizumab and bevacizumab led to complete radiological resolution.
- Significant improvement in the diffusing capacity of the lungs for carbon monoxide (DLCO) was observed.
Conclusions:
- The "atoll sign" on chest CT is a potential imaging biomarker for drug-induced organizing pneumonia.
- Discontinuation of pembrolizumab and bevacizumab is an effective treatment for this adverse pulmonary event.
- Close monitoring for pulmonary complications is crucial in patients receiving combination immunotherapy and anti-angiogenic therapy.
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