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Inclusion criteria were: clinical picture, compatible tomographic findings and clinical improvement following an adequate therapeutic conduct. Exclusion criteria were: presence of associated pulmonary diseases, clinical and tomographic investigations incompatible with pulmonary toxicity diagnosis and absence of appropriate therapeutic response.

The chest HRCT were performed in different TC devices, with acquisition of 1 mm to 2 mm thick axial slices and 10 mm increments, taken during deep inspiration, from the apex through the pulmonary bases. Images acquisition was performed on parenchymal windows width between 1. The HRCT analysis was performed independently by two observers and the final results were decided by consensus.

The study has included the pulmonary parenchyma evaluation taking into consideration the presence of consolidations, ground-glass opacities, intra and interlobular septa thickening, dense nodular opacities, architectural distortions, pleural effusion or thickening and increased density of the hepatic parenchyma. At chest HRCT the most frequent findings were linear or reticular opacities Figures 1 to 6 , especially represented by interlobular septa thickening and presence of high density small nodules Figures 2 , 3 , 5 and 6.

The analysis of the increase of the hepatic parenchyma density was feasible in CT studies including superior abdomen images. This has occurred in eight of the ten patients of our casuistic. Increased attenuation of the liver was observed in five Pleural effusion was observed in only one of the patients. Both lungs were affected in all these patients.

1. Introduction

Tomographic findings are represented in Graphic 1. The amiodarone is a pharmacological agent with several adverse side effects such as pulmonary toxicity; which constitutes the reaction that restricts more significantly its clinical use The computed tomography can be used as it presents more specific findings for this diagnosis than the chest x-ray, contributing to the distinction between amiodarone side effects and other possible differential diagnoses.

Patients' age ranged between 64 and 83 years, averaging The prevalence of male patients and of a higher age range probably is due to the higher association of elder men with coronary arterial disease and, consequently, with arrhythmias that require the use of amiodarone 9. Tomographic manifestations in patients presenting amiodarone pulmonary toxicity are variable. Usually, the patients present associated tomographic findings 1,15 , and this fact has also been observed in our study. This preferential onset in the pulmonary interstice is corroborated by the fact that the unusual interstitial pneumonia is the most common histopathologic manifestation in the amiodarone pulmonary toxicity 1, This tomographic alterations distribution is consistent with several studies available in the literature 1,2,6, The presence of macrophages with spumous or xanthomatous aspect is quite frequent in these patients, but is a non-specific finding 10, These increased-density foci are a result of the high iodine contents in the amiodarone molecule that is incorporated principally by pneumocytes type II The literature reports variable frequencies of this finding.

In some studies, the ground-glass opacity is not even described.

However, other studies like that of Siniakowicz et al. This data are consistent with the literature 9, Several authors have indicated the presence of increased density in the hepatic parenchyma as a highly specific sign, although poorly sensitive, of amiodarone pneumopathy. In our casuistic, the increase in the hepatic attenuation was evidenced in five of the eight patients to whose superior abdomen CT we have gotten access to Therefore, this data is consistent with those presented in the literature.

This distribution is comprehensively described in the literature 2,7,9,10 , also as asymmetrical and predominant in the peripheral regions of the lungs.

Secondary lobule

Finally, the HRCT finding of high density parenchymatous lesions represented by nodules or consolidations, especially when associated with increased density of the hepatic parenchyma, is highly suggestive of amiodarone-induced pulmonary toxicity. Amiodarone pulmonary toxicity. Clinical, radiologic, and pathologic correlations. Amiodarone pulmonary toxicity part 1.

Chest Imaging - Lung and Airway Disorders - MSD Manual Consumer Version

Recognition and pathogenesis. A general overview of amiodarone toxicity: its prevention, detection and management. Plain chest radiograph though inexpensive, excellent modality of choice, the pattern of diffuse lung disease on radiography is often nonspecific.

HRCT can detect normal and abnormal lung interstitium and morphological characteristics of both localized and diffuse lung diseases.

High-resolution computed tomography

Methods: A total number of 50 patients with suspected or known interstitial lung disease were studied by high-resolution computed tomography HRCT over a period of 24 months. Results: In the current study the most common cases are of tuberculosis. Diffuse infiltrative lung disease: A new scheme for description.


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  4. References.
  5. The Warlock Unlocked (Warlock Series, Book 3).
  6. Role of computed tomography in diagnosis of bronchiectasis. Bronchiectasis- assessment by thin section CT. CT of the lungs in patients with pulmonary emphysemas: Diagnosis, quantification and correlation with pathologic and physiologic findings. Normal and diseased isolated lungs: high-resolution CT.