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Effects of Radiation Therapy on the Lung: Radiologic Appearances and Differential Diagnosis¹

¹ From the Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea (Y.W.C., W.K.C., S.C.J., C.K.P.); the Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston (R.F.M., J.J.E.); and the Department of Radiology, Ajou University Medical Center, Suwon, Korea (K.J.P.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received July 7, 2003; revision requested August 25 and received October 9; accepted October 13. Supported in part by grant HY2002–1 from the research fund of Hanyang University. All authors have no financial relationships to disclose. Address correspondence to Y.W.C., Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 133–792, Korea (e-mail: ywchoi@hanyang.ac.kr).

Radiation-induced lung disease (RILD) due to radiation therapy is common. Radiologic manifestations are usually confined to the lung tissue within the radiation port and are dependent on the interval after completion of treatment. In the acute phase, RILD typically manifests as ground-glass opacity or attenuation or as consolidation; in the late phase, it typically manifests as traction bronchiectasis, volume loss, and scarring. However, the use of oblique beam angles and the development of newer irradiation techniques such as three-dimensional conformal radiation therapy can result in an unusual distribution of these findings. Awareness of the atypical manifestations of RILD can be useful in preventing confusion with infection, recurrent malignancy, lymphangitic carcinomatosis, and radiation-induced tumors. In addition, knowledge of radiologic findings that are outside the expected pattern for RILD can be useful in diagnosis of infection or recurrent malignancy. Such findings include the late appearance or enlargement of a pleural effusion; development of consolidation, a mass, or cavitation; and occlusion of bronchi within an area of radiation-induced fibrosis. A comprehensive understanding of the full spectrum of these manifestations is important to facilitate diagnosis and management in cancer patients treated with radiation therapy.

© RSNA, 2004

Index Terms: Lung, effects of irradiation on, 60.47 • Lung neoplasms, therapeutic radiology, 60.1299, 60.32 • Radiations, injurious effects, complications of therapeutic radiology, 60.47

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