Pulmonary embolism (PE) in amiodarone-induced pulmonary toxicity (AILT)

PE is a relatively common complication of cardiac arrhythmias. The aim was to study the incidence and the background of PE development in patients with AILT and to optimize its diagnosis. Materials and methods. 55 AILT patients were observed. HRCT, echocardiography (EchoCG),single photon emission computed tomography (SPECT) were performed.Results. PE of small branches of the pulmonary artery (PA) was occurred in 9 (16%, 9/55) patients (2 women and 6 men, mean age 67,1±2,0 yrs). In 3 cases – PE developed due to paroxysmal cardiac arrhythmias; in 1 patient - on the background of the replacement of warfarin on acetylsalicylic acid; in 2 cases PE was triggered by the development of acute respiratory viral infection and in 4 patients - on stable corticosteroid therapy and compensated heart disease. There were the typical clinical and EchoCG (PA systolic pressure increased to 55,7±3,3 mm Hg, signs of overloading of the right heart chambers) evidence of PE. AngioCT (1 patient) did not revealed signs thrombosis. HRCT revealed subpleural triangular shading in 3 (3/6) cases and X-rays in 1 patient (1/1) detected the discoid atelectasis. SPECT revealed diffuse perfusion violations with the typical triangular shading (5/6 cases) and subpleural irregular perfusion disturbances (1/6 cases). Anticoagulant therapy resulted in significant positive clinical, EchoCG and HRCT dynamics in all patients. The dose of glucocorticosteroids appointed over AILT was not changed. Conclusion. PE may develop in in 16% of AILT patients. One third of PE is due to cardiac causes or changes in the anticoagulant therapy and one third - as a complication of AIPT. At suspicion on PE in AIPT patients the SPECT is the most informative.