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Unusual progression and subsequent improvement in cystic lung disease in a child with radiation-induced lung injury

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Abstract

Radiation-induced lung disease is a known complication of therapeutic lung irradiation, but the features have not been well described in children. We report the clinical, radiologic and histologic features of interstitial lung disease (ILD) in a 4-year-old child who had previously received lung irradiation as part of successful treatment for metastatic Wilms tumor. Her radiologic abnormalities and clinical symptoms developed in an indolent manner. Clinical improvement gradually occurred with corticosteroid therapy. However, the observed radiologic progression from interstitial and reticulonodular opacities to diffuse cystic lung disease, with subsequent improvement, is striking and has not been previously described in children.

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Abbreviations

ABCA3 :

gene encoding the ATP-binding cassette member A-3

ILD:

interstitial lung disease

NKX2-1/TTF1 :

gene encoding the thyroid transcription factor-1

SFTPC :

gene encoding surfactant protein C

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Acknowledgments

We wish to thank Gail H. Deutsch, M.D., Department of Pathology, Seattle Children’s Hospital and University of Washington, for her thoughtful and expert clinical consultation in the evaluation of this case. We also wish to thank the many radiologists and other individuals at Monroe Carell Jr. Children’s Hospital at Vanderbilt who were involved in the care of this patient.

Authors are supported in part by grant funding through the National Institutes of Health (HL119503; L.R.Y.) and St. Baldrick’s Foundation (fellowship to C.M.C.).

Conflicts of interest

None

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Authors and Affiliations

  1. Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Michael S. Wolf

  2. Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Ashley D. Chadha & Lisa R. Young

  3. Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Clinton M. Carroll & Scott C. Borinstein

  4. Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Lisa R. Young

  5. Division of Pulmonary Medicine, Vanderbilt University School of Medicine, 2200 Children’s Way, 11215 Doctor’s Office Tower, Nashville, TN, 37232-9500, USA

    Lisa R. Young

Authors
  1. Michael S. Wolf
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  2. Ashley D. Chadha
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  3. Clinton M. Carroll
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  4. Scott C. Borinstein
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  5. Lisa R. Young
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Corresponding author

Correspondence to Lisa R. Young.

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Wolf, M.S., Chadha, A.D., Carroll, C.M. et al. Unusual progression and subsequent improvement in cystic lung disease in a child with radiation-induced lung injury. Pediatr Radiol 45, 1086–1090 (2015). https://doi.org/10.1007/s00247-014-3223-6

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  • DOI: https://doi.org/10.1007/s00247-014-3223-6

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