Radiology Teaching Files > Case 1768254

Contributed by: Residents and Faculty Baptist Health System Birmingham Alabama, Radiologist, Baptist Health System Hospitals Birmingham, Alabama, USA.
Patient: male
History: Unknown

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Findings: Two PA chest radiographs, 1984 and 1985, reveal interval (14 mo.) development of a left apical pleuroparenchymal opacity with parenchymal fibrosis extending from the left hilum. The outer border of this fibrotic parenchyma is straight, and there is mild superior retraction of the left hilum. Bony bridging between the anterior 1st through 3rd ribs is also noted on the right as is mild blunting of the left costophrenic angle.
Diagnosis: radiation fibrosis

Radiation damage to the lungs following therapy depends on irradiated volume, total dose, number of fractons and adjuvant chemotherapy. Significant damage is unusual at less than 2000 rads over 2-3 weeks and common at greater than 6000 rads given over 5-6 weeks.
Acute radiation pneumonitis occurs at approximately one month after treatment. Pathologically there is sloughing of the alveolar and bronchial cells, exudation and depletion of surfactant. Clinically there is nonproductive cough, SOB, weakness and fever. Radiographically there is initial patchy opacity and atelectasis within the port, persisting up to one month. Complete recovery or progression to death can occur. Steroid therapy is treatment of choice. Chronic radiation damage appears 9-12 months post treatment and results in volume loss, fibrosis (hilar to periphery), pleural thickening and possibly pericardial effusion. Again, the reaction is contained within the radiation portals.

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Additional Details:

Case Number: 1768254Last Updated: 2011-06-21
Anatomy: Chest   Pathology: Trauma
Access Level: Readable by all users
Keywords: apical opacity with fibrosis, chronic infection (tb, fungal), tumor, radiation fibrosis, pleural plaque/ mesothelioma, postsurgical reactionACR: 641.47

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