Snippet 31 - Radiotherapy-Associated Lung Injury
Radiotherapy-associated lung injury follows predictable patterns. History of radiotherapy, knowledge of the portal, and timelines are what separate this entity from infection, chemotherapy-induced ILD, or recurrent disease.
A short lecture on radiotherapy-associated lung injury
What's covered:
- Typical imaging evolution: ground glass → consolidation → organizing pneumonia → fibrosis
- Patterns by primary site — subpleural for breast and mediastinal nodal RT, perivascular for lung mass RT
- Post-SBRT lung changes, including mass-like fibrosis
- Why the radiation portal matters — using portal margins to distinguish RT injury from infection or chemotherapy-induced ILD
- Worked-up cases across breast, Hodgkin's, buccal, nasopharyngeal, and SBRT scenarios
- Radiation Recall Pneumonitis — definition, triggering agents (immunotherapy, targeted therapy, anti-TB drugs, vaccination, statins), pathophysiology, and the key point that prior demonstrated pneumonitis is not required as long as the recall disease conforms to the portal
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