72 yo M with 3 weeks of cough and SOB

Original case provided by Lauren Brown, MD.
Edits, teaching points and graphics by Yilin Zhang, MD.


OBJECTIVES:


CASE:

A 77 yo M with a history of atrial fibrillation, nonischemic cardiomyopathy (EF 40%) presents with 3 weeks of nonproductive cough and exertional dyspnea. He feels he “can’t take a deep breath” but denies any chest pain, orthopnea, LE edema. He denies URI symptoms, fevers/chills or recent sick contacts. At baseline, he is able to walk several miles without difficulty and now is limited to < 1 city block.

His PMH is notable for paroxysmal atrial fibrillation status post ablation for which he has been on warfarin and amiodarone for several years. He has an AICD for his history of cardiomyopathy. He previously smoked 30 pack years but quit several years ago. He has lived all around the US but denies international travel. He has 2 dogs at home and denies any other pet exposures.

CXR

 

What is your differential for these CXR findings?


CT Chest

What is your differential for this CT finding?


OUTCOME AND FINAL DIAGNOSIS:


TEACHING POINT:

What effect does amiodarone have on the lung?

How is it diagnosed?

What were our patient’s risk factors?

Can he be restarted on amiodarone after resolution of their pulmonary symptoms?


ADDITIONAL LEARNING:

Our patient additionally underwent PFTs as part of his work-up which showed:

FEV1
FVC
FEV1/FVC ratio
TLC
RV
DLCO
2.2 L (65% predicted)
3.3 L (74% predicted)
0.67
5.29 (75% of predicted)
1.5 L (61% predicted)
45% predicted

How would you interpret these PFTs?

What other organs are affected by amiodarone? 


REFERENCES:

  1. Kadoch, MA, et al. Idiopathic Interstitial Pneumonias: A Radiology-Pathology Correlation Based on the Revised 2013 American Thoracic Society-European Respiratory Society Classification System. Current Problems in Diagnostic Radiology. 2015; 44(1): 15-25.
  2. Wolkove, N & Baltzan, M. Amiodarone pulmonary toxicity. Canadian Respiratory Journal. 2009; 16(2): 43-48.