A 67-year-old man with prior mediastinal radiation for lymphoma 15 years ago presents with progressive dyspnea. Vital signs: BP 142/88, HR 98, RR 22, SpO2 88% on room air. Chest X-ray shows bilateral lower lobe fibrosis with mediastinal fibrosis. PFTs reveal reduced TLC and FVC with normal FEV1/FVC ratio. He denies orthopnea. Which pathologic process best explains his restrictive lung disease?
- A)Cardiogenic pulmonary edema from radiation-induced heart disease
- B)Infectious pneumonia from chemotherapy-induced immunosuppression
- C)Recurrent lymphoma with leukostasis
- D)Radiation-induced alveolitis with progressive pulmonary fibrosisGABARITO
- E)Bronchiolitis obliterans from graft-versus-host disease
Explicação
Radiation therapy to the mediastinum causes radiation pneumonitis (acute phase) progressing to pulmonary fibrosis. This is dose-dependent and occurs in the radiation field (lower lobes if chest irradiated). Presents as restrictive disease years after therapy c... Ver explicação completa e trilha adaptativa →