Chest
Volume 139, Issue 2, February 2011, Pages 454-459
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Postgraduate Education Corner
Pulmonary and Critical Care Pearls
Fleeting Alveolar Infiltrates and Reversed Halo Sign in Patients With Breast Cancer Treated With Tangential Beam Irradiation

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Case 1

A 71-year-old woman was referred for evaluation of an abnormal CT scan of the chest. Her medical history was significant for recent diagnosis of left-sided breast cancer treated with breast-conserving therapy (lumpectomy followed by tangential beam irradiation). Five months after her treatment, she developed fatigue, fever, productive cough, and weight loss. Chest radiographs obtained at that time revealed a left-side lung consolidation for which she received several courses of oral

Case 2

A 65-year-old woman presented for evaluation of an abnormal CT scan of the chest. Her medical history was significant for left-sided breast cancer treated with breast-conserving therapy (lumpectomy followed by tangential beam irradiation). Two months after her treatment, she developed malaise, productive cough, and fever. Chest radiographs obtained at that time revealed a lingular infiltrate for which she received oral antibiotics. CT imaging a few weeks later showed bilateral ground-glass

Discussion

Organizing pneumonia (OP) pattern is a common manifestation of lung injury and can be associated with a wide variety of entities, such as organizing infections, drug and toxic reactions, collagen vascular diseases, hypersensitivity pneumonitis, chronic eosinophilic pneumonia, diffuse alveolar damage, or post-lung or bone marrow transplantation, among others. When no etiology is established, the disease is referred to as cryptogenic OP.

Radiation-induced lung disease is common and can be seen

Clinical Pearls

  • 1.

    Radiation-induced changes can be seen in the nonirradiated lung in patients with breast cancer treated with tangential beam radiation.

  • 2.

    OP after radiation is a distinct clinical entity in patients with breast cancer, with a prevalence of 2% to 2.5%.

  • 3.

    Fleeting infiltrates and reversed halo sign are characteristic of OP.

  • 4.

    OP usually is seen between 2 and 12 months after radiation therapy in patients with breast cancer.

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Cited by (12)

  • Spontaneous resolution of thoracic radiation therapy-induced organizing pneumonia: A case series

    2019, Respiratory Medicine Case Reports
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    However, all patients who were administered steroid therapy showed recurrence; in addition, the time required for resolution of lung shadow was also longer in these patients (Table 1). Our literature search identified 173 cases of breast cancer who developed radiation therapy-induced organizing pneumonia worldwide between 1995 and 2018 [1,3,5–32]. The incidence was 1.1%–2.9%, and the average age range of patients was 52–59 years.

  • Organizing pneumonia: What is it? A conceptual approach and pictorial review

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    OP is a process of pulmonary tissue repair that can be either: secondary to a lung injury such as infection, drug toxicity, inhalation of a pathogen (cocaine), inhalation of toxic gas, gastroesophageal reflux, collagenosis, organ transplant, or radiotherapy [5–8]; it can be histologically associated with pulmonary lesions of another nature such as vasculitis, lymphoma, lung cancer [9], hypersensitivity pneumonitis, eosinophilic pneumonia, acute interstitial pneumonia, non-specific interstitial pneumonia, or usual interstitial pneumonia [5] (Table 1).

  • Nodule Characterization. Subsolid Nodules.

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    Organizing pneumonia is another potential cause of persistent subsolid nodules. Organizing pneumonia is classified as either cryptogenic (idiopathic) or secondary, associated with a variety of conditions that include infection, malignancy, connective tissue disease, drug reaction, and radiation injury.52–54 One manifestation of organizing pneumonia on chest CT is the “reversed halo sign,” defined by the Fleischner Society glossary of terms as “a focal, rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation” (Fig. 9).4

  • Cryptogenic organising pneumonia: Clinical, pathological, and prognostic analysis of 27 cases

    2016, International Journal of Clinical and Experimental Medicine
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© 2011 American College of Chest Physicians Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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