J Lung Cancer.  2012 Dec;11(2):97-101. 10.6058/jlc.2012.11.2.97.

Bilateral Diffuse Radiation Pneumonitis Caused by Unilateral Thoracic Irradiation: A Case Report

• Song SH
• Oh YJ
• Ha CW
• Chae SM

• KMID: 2199837
• DOI: http://doi.org/10.6058/jlc.2012.11.2.97

Abstract

Radiation therapy is one of the most important therapeutic modalities for the treatment of lung cancer. Radiation pneumonitis is one of the important complications associated with radiotherapy for lung cancer. Radiation pneumonitis is generally limited to the irradiated lung and is manifested by the insidious onset of dry cough, dyspnea, and mild fever, resulting in damage and edematous changes of alveolar structures on histologic inspection. Clinically, diffuse bilateral radiation pneumonitis accompanied with acute symptoms after unilateral thoracic irradiation appears very rarely. Histopathologic examinations for the diagnosis of out-of-field radiation pneumonitis are rarely performed. We herein describe a case of extensive bilateral radiation pneumonitis which developed acutely after salvage radiotherapy for squamous cell carcinoma in the left upper lobe of the lung. The condition was confirmed by a diagnostic help of histopathologic findings.

Keyword

Lung neoplasms; Radiotherapy; Radiation pneumonits

MeSH Terms

Carcinoma, Squamous Cell
Cough
Dyspnea
Fever
Lung
Lung Neoplasms
Radiation Pneumonitis

Figure

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  Fig. 1 (A) Radiation plan. (B, C) Dose volume histogram of V20.

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  Fig. 2 (A) Known lung cancer mass (arrow) in the left upper lobe. (B) Multifocal patchy infiltrative lesions in both lung fields.

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  Fig. 3 (A, B) Computed tomography scans show multifocal non-segmental ground glass opacities with partial interlobular septal thickening in both whole lung fields, which are more predominant in the peripheral zone. The arrow indicates primary remnant squamous cell carcinoma of the left upper lobe.

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  Fig. 4 (A) Bizarre, enlarged hyperchromatic type II alveolar lining cell containing a prominent nucleoli (arrow) (H&E, ×400). (B) Edema and thickening of the alveolar walls. Accumulations of alveolar macrophages are also shown (H&E, ×400).

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