Causes: Amiodarone toxicity can be caused by
prolonged use or
high doses of the medication.
The drug has a long half-life, and
toxicity may occur even after the medication is discontinued.
Pulmonary Toxicity:
interstitial pneumonitis or
fibrosis.
Thyroid Toxicity:
can cause both
hypo- and hyperthyroidism,
Hepatic Toxicity:
Imaging Characteristics:
Chest X-ray (CXR): I
interstitial infiltrates,
consolidation, or a
reticular pattern.
pleural effusion
CT (Computed Tomography):
interstitial infiltrates,
consolidation, or a
reticular pattern.
ground-glass opacities and fibrotic changes.
nodular opacities
pleural effusion
Treatment:
discontinuing or reducing the dose of amiodarone.
corticosteroids for pulmonary toxicity, may be required.
Amiodarone Therapy Started
CT Lung Bases Interstitial Process 68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. Ct scan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa, mild heterogeneous ground glass changes mosaic attenuation centrilobular nodules and bronchiolectasis suggesting a combination of small airway disease and an alveolitis with early fibrotic change. These findings are consistent with amiodarone toxicity. Ashley Davidoff MD TheCommonVein.277Lu 37873
CT Lung Bases Interstitial Process 68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. CT scan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa, mild heterogeneous ground glass changes mosaic attenuation centrilobular nodules and bronchiolectasis suggesting a combination of small airway disease and an alveolitis with early fibrotic changes . These findings are consistent with amiodarone toxicity Ashley Davidoff MD TheCommonVein.277Lu 37873c
CT Lung Bases Interstitial Process 68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. CTscan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa (a), centrilobular nodules, (b)mild heterogeneous ground glass changes (c) mosaic attenuation (d, teal ring) and small airway wall thickening and bronchiolectasis (d yellow ring) suggesting a combination of small airway disease and an alveolitis with early fibrotic changes. These findings are consistent with amiodarone toxicity. Ashley Davidoff MD TheCommonVein.277Lu 37873c02
At presentation 1 Month Later following Rx
CT Overview of Changes in Lung Lymph Nodes and Liver Before and After Cessation of Amiodarone and Initiation of Steroid Therapy 68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presented 9 months later with dyspnea. At that time he had a prominent interstitial process at his lung bases consistent with amiodarone toxicity (a) with increased density in enlarged mediastinal nodes (c) and liver (e). The amiodarone was discontinued and steroids initiated. CTscan 1 month following treatment shows improvement in the bibasilar interstitial process (b) decreased size and density of the lymph nodes, (d) and normalization of the liver density (f). These findings confirm the diagnosis of amiodarone toxicity Ashley Davidoff MD TheCommonVein.277Lu 37922c05
2nd Case
Patient with acute respiratory difficulty shows asymmetric infiltrates. Note left atrial enlargement cardiomegaly and dual lead pacemaker He is being treated with amiodarone for atrial fibrillation Ashley Davidoff MD
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CT scan through the chest shows diffuse ground glass changes with crazy paving, cardiomegaly with LV dilatation, and bilateral pleural effusions. the differential diagnosis includes amiodarone toxicity
Ashley Davidoff MD
6 Weeks Later
Amiodarone was discontinued and treated with steroids for presented amiodarone toxicity CXR 6 weeks later shows persistent but significantly improved amiodarone Ashley Davidoff MD Ashley Davidoff MD