Radiological features of paraquat-induced pulmonary fibrosis

Paraquat poisoning remains of toxicological concern as it may cause multiple organ failure after substantial ingestion, and in those less severely poisoned, pulmonary fibrosis. We describe a patient who developed paraquat-induced pulmonary fibrosis and iatrogenic atelectasis due to a right subclavian vein catheterization. The chest radiograph obtained on hospital day 3 demonstrates a right tension hemothorax. A repeat chest radiograph obtained on hospital day 4 demonstrates a large right pneumothorax. A chest radiograph obtained on hospital day 11 demonstrates resolution of the pneumothorax with development of patchy infiltrates in the left lung and right upper lobe with relative sparing of the right lower lobe. Subsequent computed tomography scans of the lung demonstrate severe disease in the aerated left lung with near resolution in the lower portions of the right lung. Our patient developed the typical clinical and radiological features of paraquat-induced pulmonary fibrosis, more marked in the left lung compared to the non-aerated right lung.