CTICasesYttrium-90-Induced Radiation Pneumonitis
Imaging findings
Initial chest radiograph and CT show bilateral, extensive, patchy consolidations predominantly involving the upper lobes and sparing the extreme lung periphery. A one-month follow-up CT demonstrates evolution of these areas into smaller, more consolidated, highly attenuating opacities with associated architectural distortion, volume loss, and scarring.
Key takeaways
Yttrium-90 (Y-90) radioembolization for hepatocellular carcinoma can cause radiation pneumonitis if there is significant hepatopulmonary shunting (typically greater than 10-20%). The radiation-induced lung injury usually manifests 1-6 months post-procedure as organizing pneumonia or permeability edema, characteristically showing upper-lung predominance when the patient was injected in a supine position.
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