CT Normal Liver Density at Time of Acute Diverticulitis
Developed Atrial Fibrillation and Started on Amiodarone
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. An abdominal CT performed at that time showed a normal liver density (52 HU)
Ashley Davidoff MD TheCommonVein.277Lu 37841
9 Months Later patient became dyspneic
New Bibasilar Interstitial Process
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. Scout CT performed shows new bibasilar interstitial process
Ashley Davidoff MD TheCommonVein.277Lu 37878
CT Lung Bases Interstitial Process
Findings are consistent with amiodarone toxicity
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. CT scan in the axial plane show new bibasilar reticular changes. These findings are consistent with amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37877b
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. Ct scan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa, mild heterogeneous ground glass changes mosaic attenuation centrilobular nodules and bronchiolectasis suggesting a combination of small airway disease and an alveolitis with early fibrotic changes. These findings are consistent with amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37873
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. CT scan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa, mild heterogeneous ground glass changes mosaic attenuation centrilobular nodules and bronchiolectasis suggesting a combination of small airway disease and an alveolitis with early fibrotic changes. These findings are consistent with amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37873c
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presents 9 months later with dyspnea. CTscan in the axial plane through the lung bases show reticular changes characterised by irregular thickening of the interlobular septa (a), centrilobular nodules, (b)mild heterogeneous ground glass changes (c) mosaic attenuation (d, teal ring) and small airway wall thickening and bronchiolectasis (d yellow ring) suggesting a combination of small airway disease and an alveolitis with early fibrotic changes. These findings are consistent with amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37873c02
CT Increased Liver and Lymph Node Density due to Amiodarone Accumulation
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He developed dyspnea 9months later and chest CT showed findings consistent with amiodarone toxicity. His abdominal CT 9 Months later shows increased density of the liver to 74HU (previously 53HU) His lymph nodes have enlarged and also show an increased density (from 52HU to 98 HU). These findings are consistent with amiodarone accumulation
Ashley Davidoff MD TheCommonVein.277Lu 37851b120303d
1 Month Following Therapy
CT Improvement 1 Month After
Amiodarone Discontinued and Steroids Started
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response but developed toxicity 9months later He was started on steroids and amiodarone was d/c’d. CTscan in the axial plane I month later shows significant improvement in the predominantly bibasilar process with mild persistence of the reticular changes (e,f) These findings confirm the diagnosis of amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37913c
Comparison
At presentation 1 Month Later following Rx
68-year-old male presented with atrial fibrillation during an acute episode of diverticulitis. He was started on amiodarone with good response. He presented 9 months later with dyspnea. At that time he had a prominent interstitial process at his lung bases consistent with amiodarone toxicity (a) with increased density in enlarged mediastinal nodes (c) and liver (e). The amiodarone was discontinued and steroids initiated. CTscan 1 month following treatment shows improvement in the bibasilar interstitial process (b) decreased size and density of the lymph nodes, (d) and normalization of the liver density (f). These findings confirm the diagnosis of amiodarone toxicity
Ashley Davidoff MD TheCommonVein.277Lu 37922c05