CTICasesAmiodarone Toxicity Presenting as Organizing Pneumonia
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Imaging findings
A cardiac patient with a CRT-D device, on amiodarone, presented with acute shortness of breath. Chest CT showed extensive bilateral, multilobar parenchymal opacities with a geographic distribution and "crazy paving" appearance, along with interlobular septal thickening. Confluent and smaller centrilobular/acinic nodules were observed, distributed diffusely and asymmetrically, but without features typical of hydrostatic pulmonary edema or pleural fluid. Bronchoalveolar lavage (BAL) revealed numerous foamy macrophages.
Key takeaways
This is a classic case of amiodarone pulmonary toxicity, which pathologically manifests as organizing pneumonia. The CT findings, characterized by geographic opacities, crazy paving, and centrilobular nodules that can become confluent, are highly suggestive in a patient on amiodarone. The presence of numerous foamy macrophages in BAL, due to amiodarone's inhibition of phospholipase A, further supports the diagnosis. Differentiating from hydrostatic edema is key due to the lack of typical signs like interstitial lung edema or pleural fluid.
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