胺碘酮致肺损伤的临床病理分析

目的探讨胺碘酮致肺损伤的临床、病理和影像学特征。方法回顾性分析3例胺碘酮致肺损伤临床表现、影像学及病理表现、治疗及预后。结果3例男性患者,年龄35～64岁,就诊时病程20d～3年。均有咳嗽,2例有气短及肺部爆裂音。双肺片状浸润影、磨玻璃样变、弥漫索条及网格状改变为胸部CT主要表现。病理表现为富细胞性间质性肺炎改变;肺泡腔内见巨噬细胞聚集,部分巨噬细胞胞质呈细空泡状;肺泡Ⅱ型上皮细胞增生;1例可见机化性肺炎表现。结论胺碘酮致肺损伤病理表现有一定的特点,诊断应结合临床及影像综合考虑。

Clinicopathologic manifestation of amiodarone-induced lung injury

Objective To study the clinical, pathologic and radiologic features of amiodarone-induced lung injury. Methods The clinical, pathologic and radiologic features, including treatment and follow-up information of three cases diagnosed as amiodarone-induced lung injury from October 2004 to October 2005 in the Peking Union Medical College Hospital were reviewed. Results All the patients were males, with age ranging from 35 to 64 years. The duration of symptoms varied from 20 days to 3 years. All presented with cough. Worsening dyspnea and inspiratory crackles were noted in two patients. Computerized tomography showed bilateral patchy infiltration, ground-glass appearance and accentuation of bronchovascular markings. The most common pathologic manifestations included cellular interstitial pneumonia associated with intra-alveolar collections of macrophages and type II pneumocyte hyperplasia. Some of the macrophages contained finely vacuolated cytoplasm. An organizing pneumonia pattern was seen in one patient. Conclusions Amiodarone-induced lung injury has characteristic pathologic features which may provide clues to diagnosis. Correlation with clinical and radiologic findings is also important.