Images in Clinical Medicine
Radiation Pneumonitis after Radiotherapy for Breast Cancer
N Engl J Med 2009; 361:e65December 31, 2009
- Article
A 58-year-old woman with a history of stage I cancer in the right breast (T1N0M0, according to the tumor–node–metastasis classification) presented with a 2-week history of shortness of breath and cough. Eight months before presentation, she had undergone lumpectomy and adjuvant radiotherapy to the affected breast. Over a period of 5 weeks, the patient had been treated with a total dose of 50 Gy of radiation over the targeted field, which included breast parenchyma and a portion of the anterior lung, as shown on computed tomography (CT) with superimposed isodose lines (Panel A). The radiotherapy had ended 6 months before presentation. Subsequent CT showed typical features of radiation pneumonitis, which included consolidation in a nonanatomical distribution that did not conform to lobes or bronchopulmonary segments (Panel B). Many air bronchograms are visible with slight dilatation of peripheral bronchi, which often progresses to traction bronchiectasis. Although pneumonitis occurs mainly within the irradiated areas of the lung, it may spread to nonirradiated areas. The patient was given prednisolone at a dose of 100 mg once a day for 3 days, with the dose then slowly reduced, and her symptoms resolved after 5 weeks of treatment (Panel C).
Edwin Bölke, M.D.
Christiane Matuschek, M.D.
University of Düsseldorf, Düsseldorf, Germany
boelke@med.uni-duesseldorf. de
