Nodular amiodarone lung disease
The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic anal...
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th-mahidol.194952018-07-12T09:37:21Z Nodular amiodarone lung disease Ruchira Ruangchira-Urai Thomas V. Colby Julianne Klein G. Petur Nielsen Richard L. Kradin Eugene J. Mark Massachusetts General Hospital Mayo Clinic Scottsdale-Phoenix, Arizona Mahidol University Saint Boniface General Hospital Medicine The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 patients with nodular ALD, all of whom had excision of a nodule and none had a preoperative diagnosis of ALD. The radiographic suspicion before excisional biopsy in all 4 cases was malignancy. The initial pathologic suspicion in all 4 cases was either an abscess or vasculitis. In 3 of the 4 cases, where the dosages were known, each patient received 800mg/d for 7 or more months. All cases have strikingly similar histopathology, with vacuolated histiocytes massed within alveoli to form macroscopic nodules with tissue breakdown. Ultrastructural examination of lung and peripheral nerve in 1 case showed the characteristic inclusions of amiodarone in the cytoplasm of swollen histiocytes. Vacuolated histiocytes filled with these inclusions indicate the effect of the drug, but in these 4 cases there was tissue destruction, which indicated disease. The necrotizing nature of the massed histiocytes in the absence of infection or obstruction suggests the correct etiologic diagnosis even when the history of administration of the drug is not available at initial review. © 2008 by Lippincott Williams & Wilkins. 2018-07-12T02:37:21Z 2018-07-12T02:37:21Z 2008-11-01 Article American Journal of Surgical Pathology. Vol.32, No.11 (2008), 1654-1660 10.1097/PAS.0b013e31816d1cbc 15320979 01475185 2-s2.0-56149127253 https://repository.li.mahidol.ac.th/handle/123456789/19495 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=56149127253&origin=inward |
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The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 patients with nodular ALD, all of whom had excision of a nodule and none had a preoperative diagnosis of ALD. The radiographic suspicion before excisional biopsy in all 4 cases was malignancy. The initial pathologic suspicion in all 4 cases was either an abscess or vasculitis. In 3 of the 4 cases, where the dosages were known, each patient received 800mg/d for 7 or more months. All cases have strikingly similar histopathology, with vacuolated histiocytes massed within alveoli to form macroscopic nodules with tissue breakdown. Ultrastructural examination of lung and peripheral nerve in 1 case showed the characteristic inclusions of amiodarone in the cytoplasm of swollen histiocytes. Vacuolated histiocytes filled with these inclusions indicate the effect of the drug, but in these 4 cases there was tissue destruction, which indicated disease. The necrotizing nature of the massed histiocytes in the absence of infection or obstruction suggests the correct etiologic diagnosis even when the history of administration of the drug is not available at initial review. © 2008 by Lippincott Williams & Wilkins. |
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Massachusetts General Hospital |
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Massachusetts General Hospital Ruchira Ruangchira-Urai Thomas V. Colby Julianne Klein G. Petur Nielsen Richard L. Kradin Eugene J. Mark |
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Article |
author |
Ruchira Ruangchira-Urai Thomas V. Colby Julianne Klein G. Petur Nielsen Richard L. Kradin Eugene J. Mark |
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Ruchira Ruangchira-Urai |
title |
Nodular amiodarone lung disease |
title_short |
Nodular amiodarone lung disease |
title_full |
Nodular amiodarone lung disease |
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Nodular amiodarone lung disease |
title_full_unstemmed |
Nodular amiodarone lung disease |
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nodular amiodarone lung disease |
publishDate |
2018 |
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https://repository.li.mahidol.ac.th/handle/123456789/19495 |
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1763497222896353280 |