Bleomycin-related lung damage: CT evidence.

Abstract

Computed tomography (CT) examinations of the chest were evaluated in 100 patients treated with bleomycin. The CT findings were compared with those of conventional chest radiographs and lung-function tests. Lung damage due to bleomycin was detected in 38% of patients by CT, while damage was detected in only 15% by radiography. Changes in appearance seen on CT scans due to bleomycin damage were compared with measurements of lung volume and gas transfer per unit lung volume. There was good correlation between severity of damage shown on CT scans and changes in lung volume (P less than 0.01). Gas transfer capabilities were reduced in most patients regardless of changes observed on CT scans. Sequential CT studies showed that complete resolution of bleomycin damage may occur within 9 months in patients with minor or moderate damage. Residual abnormalities were seen in all patients with severe damage. CT can confirm lung damage in a patient with suspected toxicity but a normal chest radiograph and can define the anatomic extent of disease in a patient with an abnormal lung-function test.

Lung Fibrosis 10 Years after Cessation of Bleomycin Therapy

“…On CT scanning, abnormal findings due to BLM appear earlier than on chest radiographs. Damage to the lungs is seen as pleural-based linear and nodular irregularities and is the most evident at the posterior lung bases (Bellamy et al 1985). Spontaneous pneumothorax by BLM-induced pneumonitis has also been reported (Jain et al 2005).…”

“…Chest radiograph is reported to be inadequate to detect an early stage of BLM-induced pneumonitis (Bellamy et al 1985), however the 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is considered as a potent useful tool for early diagnosis (Buchler et al 2007). Although reduction of diffusing capacity for carbon monoxide in pulmonary function test is an index for continuation of BLM during treatment, the vital capacity and the total lung capacity are more specific values for detecting early phase of BLM-induced pneumonitis (Sleijfer 2001).…”

Beyond Conventional Therapy: Role of Pulse Steroids in Bleomycin Induced Lung Injury

“…15,16 High-resolution computed tomography of the chest can demonstrate ground-glass opacities, subpleural nodules, linear reticular markings, or honeycombing and traction bronchiectasis, depending on the underlying pathology and chronicity of disease. 17,18 Histopathological changes in bleomycin inducedinterstitial pneumonitis include type I pneumocyte necrosis, type II cell hyperplasia, and polymorphonuclear leukocytic infiltration. Bleomycin-induced organizing pneumonia, on the other hand, is characterized by the presence of budding granulation tissue within the alveolar air space.…”

Adverse drug reactions and the respiratory system

“…BOOP induced by bleomycin is frequently nodular and may mimic metastasis. 11 Bleomycin exposure with subsequent exposure to high inspired oxygen is associated with an increased incidence of lung toxicity. Hence patients who have had bleomycin in the previous 6 months should ideally not receive high flow oxygen.…”