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Original Research: DIFFUSE LUNG DISEASE |

131I-Labeled Lipiodol-Induced Interstitial Pneumonia: A Series of 15 Cases

Stéphane Jouneau, MD, PhD; Elodie Vauléon, MD; Sylvie Caulet-Maugendre, MD, PhD; Elisabeth Polard, PharmD; Anne-Claire Volatron, MD; Catherine Meunier, MD; Pierre Tattevin, MD, PhD; David Montani, MD, PhD; Etienne Garin, MD, PhD; Jean-Luc Raoul, MD, PhD; Philippe Delaval, MD
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From the Respiratory Diseases Department (Drs Jouneau and Delaval), Histopathology Department (Dr Caulet-Maugendre), Clinical Pharmacology Department (Dr Polard), Pharmacovigilance, Radiology Department (Dr Meunier), Infectious Diseases and Intensive Care Department (Dr Tattevin), and Nuclear Medicine Department (Dr Garin), Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University; and Medical Oncology Department (Drs Vauléon and Raoul), Centre Eugène Marquis, European University in Brittany, Rennes; Intensive Care Department (Dr Volatron), Pau Hospital, Pau; and Respiratory Diseases Department (Dr Montani), INSERM U999, Paris-Sud 11 University, Centre National de Référence de l’Hypertension Pulmonaire Sévère, Hôpital Antoine-Béclère, Assistance Publique–Hôpitaux de Paris, Clamart, France.

Correspondence to: Stéphane Jouneau, MD, PhD, Respiratory Diseases Department, Pontchaillou University Hospital, IRSET, UPRES EA 4427 SeRAIC, Rennes 1 University, Rennes, France; e-mail: Stephane.jouneau@chu-rennes.fr


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1463-1469. doi:10.1378/chest.10-1591
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Background:  The drug 131I-labeled lipiodol is used as internal radiotherapy for unresectable hepatocellular carcinoma. Although the drug was considered safe during preapproval studies, we observed several cases of interstitial pneumonia following its administration.

Methods:  Cases were retrospectively identified through the drug safety unit database of Rennes University Hospital.

Results:  From 1994 to 2009, interstitial pneumonia developed in 15 patients following 131I-labeled lipiodol administration, with an estimated prevalence of 15.5 cases (95% CI, 7.7-23.2) per 1,000 treated patients. Mean age of the patients was 60 ± 8 years, and the male to female ratio was 6.5:1. All patients had cirrhosis, mainly related to long-term alcohol intoxication (n = 12). Most (n = 10) cases occurred after the second 131I-labeled lipiodol injection. The median delay between last 131I-labeled lipiodol administration and first respiratory symptoms was 30 days (interquartile range, 16.5-45 days). All patients presented with shortness of breath. Physical examination mostly revealed fever (n = 11) and bilateral crackles (n = 12). Chest CT scan showed bilateral ground-glass opacities (n = 8) with septal thickening, retraction, or both (n = 8). BAL (n = 7) was remarkable for increased neutrophils (n = 4) or CD8+ T cell count (n = 3). Despite corticosteroids, 12 (80%) patients died, mostly of untractable respiratory failure (n = 9). Median delay between last 131I-labeled lipiodol injection and death was 63 days (interquartile range, 34-129 days).

Conclusions:  Interstitial pneumonia may be a serious and not uncommon complication of 131I-labeled lipiodol administration.

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