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Radiation-Induced Lung Injury: A Hypersensitivity Pneumonitis?

Peter G. Gibson, MBBS; David H. Bryant, MDBS; Graeme W. Morgan, MBBS; Michael Yeates, MBBS; Viviene Fernandez, MBBS; Ronald Penny, MDBS, DSc; and Samuel N. Breit, MDBS
[+] Article, Author, and Disclosure Information

Requests for Reprints: Samuel N. Breit, MDBS, Centre for Immunology, St. Vincent's Hospital, Victoria Street, Sydney, NSW 2010, Australia.

Current Author Addresses: Dr. Gibson, Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital, 50 Charlton Avenue, East Hamilton, Ontario, L8N 4A6.

Dr. Bryant: Department of Thoracic Medicine, St. Vincent's Hospital, Sydney, NSW 2010, Australia.

Dr. Morgan: Department of Radiation Oncology, St. Vincent's Hospital, Sydney, NSW 2010, Australia.

Drs. Yeates and Fernandez: Department of Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW 2010, Australia.

Drs. Penny and Breit: Centre for Immunology, St. Vincent's Hospital; and University of New South Wales, Sydney, NSW 2010, Australia.

©1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(4):288-291. doi:10.7326/0003-4819-109-4-288
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Radiation pneumonitis occurs 6 to 12 weeks after thoracic irradiation, and is thought to be due to direct radiation-induced lung injury. Four patients who developed pneumonitis after unilateral thoracic irradiation for carcinoma of the breast were studied with bronchoalveolar lavage, gallium scan of the lung, and respiratory function tests. On the irradiated side of the chest, all four patients showed an increase in total cells recovered from the lavage fluid and a marked increase in the percentage of lymphocytes. When results for the unirradiated lung were compared with results for the irradiated lung, there was a comparable increase in total cells and percentage of lymphocytes. Gallium scans showed increases for both irradiated and unirradiated lungs. Prompt improvement was seen after corticosteroid therapy in all patients. The fact that abnormal findings occur equally in irradiated and unirradiated lung is inconsistent with simple direct radiation-induced injury and suggests an immunologically mediated mechanism such as a hypersensitivity pneumonitis.





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