CTICasesRadiation Recall Pneumonitis
Imaging findings
In a patient with prior mediastinal radiation for lymphoblastic lymphoma who was clinically clear a year later, serial chest radiographs obtained after intrathecal methotrexate administration and an allogeneic stem cell transplant show new, dramatic consolidation that conforms precisely to the prior radiation port; treatment with prednisone produces gradual clearing on follow-up radiographs over the following weeks.
Key takeaways
New opacity that precisely recapitulates a prior radiation field, occurring after an unrelated systemic trigger such as chemotherapy or an allogeneic transplant, represents radiation recall pneumonitis rather than a de novo infectious or malignant process; the geographic match to the old radiation port is the key diagnostic clue, and the process typically responds to corticosteroids.
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