Amiodarone lung toxicity presented atypically in a 77-year-old man as multiple spiculated pulmonary masses and an organizing pneumonia pattern, mimicking malignancy on imaging.
Case Report (n=1)
Amiodarone lung toxicity can present atypically as FDG-avid spiculated pulmonary masses mimicking lung cancer, highlighting the importance of tissue confirmation to prevent unnecessary oncologic work-up.
Abstract Introduction Amiodarone, a class III antiarrhythmic, is effective for supraventricular and ventricular arrhythmias but can cause pulmonary toxicity as its most serious adverse effect. Toxicity usually appears as diffuse interstitial pneumonitis or ground-glass opacities. We describe an unusual presentation with multiple spiculated pulmonary masses and an organizing pneumonia pattern, radiographically resembling malignancy, an uncommon presentation that has only rarely been reported in the literature. Case Description A 77-year-old man with hypertension, atrial fibrillation on long-term amiodarone, peripheral vascular disease, and remote smoking history (30 pack-years, quit 8 years prior) presented with intermittent hemoptysis but no fever or constitutional symptoms. Family history included gastric cancer; there was no asbestos exposure.CT chest showed three solid, spiculated, high-attenuation masses (two left lower lobe, one right upper lobe), mediastinal lymphadenopathy, and a right pleural effusion. The liver appeared hyperdense, suggesting amiodarone deposition. PET revealed increased uptake in the pulmonary lesions.Robotic bronchoscopy with cryobiopsies of both lobes and EBUS-guided FNA of mediastinal/hilar nodes (11L, 4L, 7, 4R, 11RS) was performed. Final pathology showed an organizing pneumonia pattern with granulomatoid inflammation lacking well-formed granulomas and no malignancy. Discussion Amiodarone lung injury typically presents as diffuse interstitial changes; mass-like lesions are rare but reported. FDG-avid spiculated nodules can closely mimic lung cancer, making tissue confirmation essential. Our case reinforces that drug toxicity can produce PET-positive masses and granulomatoid organizing pneumonia. Awareness prevents misdiagnosis and unnecessary oncologic work-up. Prior reports (Bhall et al., Fraig et al., Oyama et al.) similarly caution that amiodarone toxicity may masquerade as malignancy. This case also provides an extrapolated thinking point for consideration as to whether liver appearance on CT can be used as a screen for possible amiodarone deposition in suggestive clinical cases. Diffuse high attenuation in the liver and sometimes spleen in a patient on chronic amiodarone strongly suggests iodine deposition. Conclusion For patients on chronic amiodarone with new masses, consider drug-related injury early. Timely biopsy can avert delays, and discontinuation of amiodarone may halt progression or allow recovery. References: Bhalla M, Kaushik S, Eng J. Amiodarone pulmonary toxicity presenting as multiple pulmonary nodules. J Thorac Imaging. 1991;6(1):82-84. Fraig M, Shilo K, Moran CA. Amiodarone-induced pulmonary toxicity with organizing pneumonia pattern. Arch Pathol Lab Med. 2002;126(1):49-51. This abstract is funded by: None
Murray et al. (Fri,) conducted a case report in Amiodarone Induced Lung Toxicity (n=1). Amiodarone was evaluated. Amiodarone lung toxicity presented atypically in a 77-year-old man as multiple spiculated pulmonary masses and an organizing pneumonia pattern, mimicking malignancy on imaging.