CTICasesPembrolizumab-Induced Pneumonitis
Imaging findings
CT chest shows peripheral consolidations, reverse halo signs, and centrilobular tree-in-bud nodularity in a patient with lung adenocarcinoma treated with pembrolizumab (Keytruda). The findings represent a combination of organizing pneumonia and drug-induced bronchiolitis.
Key takeaways
Immune checkpoint inhibitors (such as pembrolizumab) can cause drug-induced pneumonitis. The most common patterns are organizing pneumonia and hypersensitivity pneumonitis, but bronchiolitis with tree-in-bud opacities is a rare variant (6% of cases). Management is based on symptom severity and typically involves corticosteroids and dose modulation.
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