Pulmonary clearance of technetium 99m diethylene triamine penta-acetic acid aerosol in patients with amiodarone pneumonitis

Abstract

Amiodarone pneumonitis is a serious complication that may lead to fatal lung fibrosis. In an attempt to diagnose this condition as early as possible, the technetium-99m-labelled diethylene triamine penta-acetic acid (99mTc-DTPA) aerosol washout rates of 10 non-smoking normal volunteers (group 1), 10 non-smoking patients on a long-term amiodarone regimen with dilated cardiomyopathy but no congestive heart failure (group II) and 10 patients with amiodarone pneumonitis (group III) were compared. Spirometric measurements, as percentage predicted, were higher in group I than in group III (P less than 0.05). The global mean effective half-lives of 99mTc-DTPA aerosol for both lungs together in minutes were 65 +/- 14, 55 +/- 16 and 27 +/- 4 for groups I, II and III, respectively. Group III values were significantly lower than those of groups I and II (P less than 0.05). Our results demonstrated that amiodarone pneumonitis alters the alveolar-capillary membrane permeability to hydrophilic molecules. The pulmonary clearance of 99mTc-DTPA aerosol is a useful test in the differentiation of patients on a long-term amiodarone regimen without side effects from patients with amiodarone pneumonitis. The test is rapid, easy to perform and has the potential for playing an important role in deciding which patients should discontinue therapy.

Pulmonary technetium-99m diethylene triamine penta-acetic acid aerosol clearance as an index of lung injury

“…Cardiac failure does not significantly alter alveolar capillary permeability and so the clearance rate of DTPA in these conditions is normal [15] and should be able to separate cärdiogenic ffom an alveolific cause of breathlessness. Terra-Filho et al [33] demonstrated thät clearance rates were faster than in normal smokers and in patients receiving amiodarone but with no respiratory problems. DTPA clearance was more sensitive than spirometry in the detection of this condition.…”

Tc-99m HMPAO Scintigraphy in Amiodarone-Induced Acute Lung Toxicity

“…Increased lung uptake of Tc-99m HMPAO is demonstrated during therapy and lung uptake is still continuing 3 weeks after amiodarone (AD) therapy was stopped. 12 In our patient, Tc-99m DTPA clearance from the lungs during therapy was increased compared with Tc-99m DTPA scintigraphy after cessation of therapy. patients.…”

“…Tc-99m HMPAO lung scintigraphy during (A) and after therapy (B) are seen. 12,13 Increase alveolar clearance of Tc-99m DTPA from the lungs was demonstrated in AD-induced lung toxicity. Because of the long half-life of AD, this persistent lung uptake may demonstrate lung inflammation resulting from AD lung toxicity.…”

Bleomycin lung toxicity detected by technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy

“…It is also a useful method for differentiating patients on a long-term amiodarone regimen without side-effects from patients with amiodarone pneumonitis (Terra-Filho et al 1990). This justifies the use of radioaerosol lung scintigraphy to monitor patients receiving bleomycin, in whom any resulting damage basically involves alveolar epithelial cells (Adamson and Bowden 1974).…”