CTICasesAmiodarone-Induced Pulmonary Toxicity
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Imaging findings
Chest radiography and CT demonstrate bilateral, extensive, patchy, and confluent ground-glass opacities accompanied by architectural distortion and traction bronchiectasis, indicating underlying fibrosis. Small pleural effusions are also present. The liver and thyroid show normal attenuation without the expected hyperdensity from iodine accumulation.
Key takeaways
Amiodarone pulmonary toxicity is a potentially fatal adverse effect that can present subacutely as organizing pneumonia, diffuse alveolar damage, or progressive fibrosis, sometimes within less than a year of treatment initiation. Histologic examination characteristically shows vacuolated, foamy alveolar macrophages, alveolar septal thickening, and hyperplastic type II pneumocytes. While a dense, hyperattenuating liver or thyroid on non-contrast CT due to amiodarone accumulation can provide a diagnostic clue, its absence does not rule out toxicity, which is often an immunologic or direct toxic reaction.
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