Those undergoing major cardiothoracic surgery are known to be predisposed to APT. These are postulated to be accumulations of amiodarone in areas of previous inflammation. Pulmonary nodules can be seen, frequently in the upper lobes. Infiltrates with a ‘ground-glass’ appearance appreciated on HRCT are more definitive than chest x-ray. Typically the lungs manifest a diffuse interstitial pneumonitis with varying degrees of fibrosis. A course of oral prednisone without antibiotics was initiated, and after one week of treatment the chest film cleared, the PaO2 value normalized and dyspnea resolved.ĪPT occurs via cytotoxic T cells and indirectly by immunological reaction. APT was suspected and amiodarone was discontinued. A chest high-resolution computed tomography on post-operative day 3 showed extensive and severe bilateral ground glass opacities. Daily chest x-rays showed worsening of bilateral interstitial infiltrates and pleural effusions. Physical exam found bilateral rhonchi with bibasilar crackles and subcutaneous emphysema along the left anterior chest wall. Patient also complained of new onset dyspnea.
The patient was found to be hypoxemic with a PaO2 52 mmHg and bilateral infiltrates on chest x-ray. Post-operatively, the patient was admitted to the ICU for ventilator management and continued to receive his home dose of amiodarone 400 mg orally twice daily, which he had been taking for the past 3 months. A 56-year-old male with a past medical history of coronary artery disease and chronic obstructive pulmonary disease was admitted for a coronary artery bypass graft.
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