Source: Annual Congress 2002 - Treatment and outcome of acute respiratory failure in chronic disease
Disease area: Interstitial lung diseases

Abstract

Introduction: we report on an apparently undescribed association of infiltrative lung disease, and intrahepatic administration of radioactive ¹³¹I in iodinated oil, for the treatment of hepatocellular carcinoma (HCC).
Cases: three HCC patients (2F) with alcoholic cirrhosis underwent intrahepatic injection(s) of 60 mCi ¹³¹iodine in oil (Lipiocis ®). All three patients developed a severe pulmonary reaction after the first (n=1), second (n=1), and first and second (n=1) injection. Time to onset of the pulmonary reaction was a few hours, two weeks, and two months, respectively. In one patient, the picture was the adult respiratory distress syndrome (ARDS), whereas in the two others, a milder form of infiltrative lung disease was observed. Bronchoalveolar lavage (BAL) was performed in 2 patients, and the pattern was neutrophilic in one. No microorganisms were found in BAL fluid. Lung histology was obtained in no case. Corticosteroids were given to all three patients, with no discernible effect. One patient died from ARDS, one from the evolution of the HCC, and one patient remains stable with substantial ventilatory impairment, precluding liver transplantation. Fifteen other cases exhibiting similar features are in the process of being analyzed.
Suggestion: these cases suggest a temporal association between intrahepatic injection of ¹³¹I in oil, and the development of infiltrative lung disease, sometimes severe. Whether the reaction results from the idoninated oil, or is a form of radiation pneumonitis as described with other isotopes is currently unknown. The possiblility that portal hypertension plays a potentating role remains to be examined

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Citations should be made in the following way:
P. Camus, G. LeGarff, F. Combes, F. X. Lebas, M. Messner, P. Delaval (Dijon, Rennes, Le Mans, France). Severe pulmonary complications in hepatocellular carcinoma patients treated with radioactive iodine (¹³¹I). Eur Respir J 2002; 20: Suppl. 38, 603

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