Fleeting Alveolar Infiltrates and Reversed Halo Sign in Patients With Breast Cancer Treated With Tangential Beam Irradiation

Gudavalli, Ravindra; Diaz-Guzman, Enrique; Arrossi, Andrea V.; Chapman, Jeffrey T.; Mehta, Atul C.

doi:10.1378/chest.10-1573

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…Chest radiographs showed infiltrates with air bronchograms [13, 29- bronchograms [32,39,43,45].Migrating infiltrates werenoted in several reports [13,14,30]. Infrequent abnormalities included nodules [28,41], coin lesion [29], and reverse halo sign [45]. Although most of the 34 patients were originally diagnosed with community-acquired pneumonia and treated with antibiotics, 9 patients were initially diagnosed with postradiation pneumonitis [14, 29-31, 38, 39, 41].…”

Section: Resultsmentioning

confidence: 99%

“…Total duration of steroid use for patients who relapsed often exceeded 1 year, with several patients still receiving steroid therapy by the time of study publication [14,37,41,48]. Among the eight patients who were not treated with corticosteroids, BOOP resolved spontaneously in four [28, 30,45,49], after trastuzumab was discontinued in two [33,44], after macrolide therapy in one [30], and after nodule resection in one [30]; the remaining case report had no treatment information [42].…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

Epler

Kelly

2014

The Oncologist

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Background. Radiation therapy for breast cancer has been implicated in the development of bronchiolitis obliterans organizing pneumonia (BOOP).This inflammatory lung disorder was first noted in 1983, and there have been numerous reports of BOOPoccurring in womenwho have had radiation therapy for breast cancer since 1995.This study was undertaken to perform a systematic review of postradiotherapy BOOP to determine the occurrence, presentation, treatment, and outcome. Materials and Methods. A systematic literature review was conducted according to the guidelines provided by the Preferred ReportingItemsforSystematicReviewsandMeta-Analysesreport. Results. The literature search yielded 10 Japanese epidemiological reports with 129 women, 4 case series reports with 36

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

Epler

Kelly

2014

The Oncologist

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“…Although several publications have attributed the RHS directly to different diseases (dermatomyositis [18], lipoid pneumonia [19], radiotherapy [17], nonspecific interstitial pneumonia [20]), descriptions of the pathologic findings in these cases show evidence of secondary OP (e.g., presence of polypoid granulation tissue).Thus, the RHS most likely represented secondary OP as a response to the primary disease in these cases. In other cases, such as in one patient with pneumococcal pneumonia [21], the RHS appeared during the resolution phase of the disease, days or weeks after the diagnosis of pulmonary infection had been made.…”

Section: Organizing Pneumoniamentioning

confidence: 95%

“…COP is classified as an idiopathic interstitial pneumonia, whereas secondary OP is associated with a variety of diseases presenting with OP clinical syndrome and the characteristic pathologic pattern. These entities include connective tissue diseases, infections, malignancies, drugs, radiation injury, organ transplantation, hypersensitivity pneumonitis, chronic eosinophilic pneumonia, diffuse alveolar damage, and aspiration, among others [15][16][17]. COP is diagnosed in the appropriate clinical, radiographic, and pathologic setting after excluding diseases associated with secondary OP.…”

Section: Organizing Pneumoniamentioning

confidence: 99%

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

Marchiori

Zanetti

Hochhegger

et al. 2012

Lung

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The reversed halo sign (RHS) is a chest computed tomography (CT) pattern defined as a focal round area of ground-glass attenuation surrounded by a crescent or ring of consolidation. The RHS was first described as being relatively specific for cryptogenic organizing pneumonia but was later observed in several other infectious and noninfectious diseases. Although the presence of the RHS on CT may help narrow the range of diseases considered in differential diagnoses, final diagnoses should be based on correlation with the clinical scenario and the presence of additional disease-specific CT findings. However, frequently a biopsy may be needed to establish the diagnosis. Organizing pneumonia is the most frequent cause of the RHS. This is a distinct clinical and pathologic entity that can be cryptogenic or secondary to other known causes. Morphologic aspects of the halo, particularly the presence of small nodules in the wall or inside the lesion, usually indicate an active granulomatous disease (tuberculosis or sarcoidosis) rather than organizing pneumonia. Immunocompromised patients presenting with the RHS on CT examination should be considered to have an infection until further analyses prove otherwise. Pulmonary zygomycosis and invasive pulmonary aspergillosis are typically seen in patients with severe immunosuppression, most commonly secondary to hematological malignancies. Other causes of the RHS include noninvasive fungal infections such as paracoccidioidomycosis, histoplasmosis, and Pneumocystis jiroveci pneumonia. Furthermore, Wegener's granulomatosis, radiofrequency ablation, and lymphomatoid granulomatosis may also lead to this finding. Based on a search of the PubMed and Scopus databases, we review the different diseases that can manifest with the RHS on CT.

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“…Since Crestani et al [4]. reported OP after postoperative irradiation for breast cancer in 1998, several reports have described the features, which are different from those of radiation pneumonitis (RP) [5-10]. The infiltrates initially appear in the irradiated side of the lung and migrate outside the radiation field.…”

Section: Introductionmentioning

confidence: 99%

Organizing pneumonia after stereotactic ablative radiotherapy of the lung

et al. 2012

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BackgroundOrganizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR).MethodsPatients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause.ResultsAmong 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis.ConclusionsThis is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP.

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Fleeting Alveolar Infiltrates and Reversed Halo Sign in Patients With Breast Cancer Treated With Tangential Beam Irradiation

Cited by 11 publications

References 5 publications

Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

Organizing pneumonia after stereotactic ablative radiotherapy of the lung

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