PURPOSE: Amiodarone pulmonary toxicity is recognized as a serious adverse reaction and can be challenging to diagnose. Findings on chest radiography and computed tomography (CT) have been described. To date, no reports of lung and pleural ultrasound findings of amiodarone toxicity have been published.
METHODS: Comprehensive pleural and pulmonary sonography was performed on three patients as part of their standard examinations by a research fellow (JC). These patients were clinically suspected to have amiodarone toxicity which was supported with the use of chest radiographs, CT and bronchoscopy.
RESULTS: Lung and pleural ultrasound in one patient revealed areas of heterogeneously distributed decreased lung sliding, increased B line score and scattered areas of pleural thickening, as well as hepatization of the lung and multiple sonographic air bronchograms. The right parasternal pleura was hyperechoic, irregular and thickened at 10 mm. The second patient displayed heterogeneously decreased lung sliding, pleural thickening and patchy areas of increased B lines. The pleura was measured to be 4.5 mm at its thickest point. The third patient also had a pattern of heterogeneously decreased lung sliding, increased B lines and patchy areas of pleural thickening.
CONCLUSIONS: All three patients demonstrated heterogeneously distributed areas of decreased lung sliding, increased B line score and scattered areas of pleural thickening. All had CT scans, two of which were read by an attending radiologist as suspicious for amiodarone pulmonary toxicity and one CT was consistent with hepatic uptake of amiodarone as well.
CLINICAL IMPLICATIONS: This is the first sonographic description of amiodarone pulmonary toxicity. Future applications may include serial follow up examinations. Ultrasound is a valuable and affordable modality that may aid in the diagnosis and monitoring of amiodarone pulmonary toxicity.
DISCLOSURE: The following authors have nothing to disclose: Jonathan Caronia, Klaus Lessnau, Wojciech Palka, Larry Difabrizio, Eric Berkowitz, Bushra Mina
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