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P. Bonniaud and P. Camus

 

 

following administration of chemotherapy or ICI. Other examples include ARDS triggered by oxygen in patients previously exposed to amiodarone [127].

Thoracic Bezoars: Gossipybomas

Bezoars and pharmacobezoars are aggregates of food or other foreign material or drugs. They may localize in the chest, obstructing the central airway or esophagus (sometimes rendering the esophagus spontaneously visible on a chest radiograph).

Pharmacobezoars including body packing may act as a slow release drug reservoir capable of releasing the drug and “mysteriously” perpetuating the adverse effects despite apparent withdrawal of the drug [189].

Postoperative leftovers (surgical sponge, throat packs, surgical fabric or catheters) may lead to a foreign body retention named gossypibomas or textilomas [3, 4]. These have distinctive HRCT features [190] and can simulate chest malignancy [191, 192].

Respiratory Diseases Considered Idiopathic That May Be Drug-Induced (Table 42.4)

A number of common diseases commonly named as “idiopathic” including such ILD as cellular NSIP, organizing pneumonia, pulmonary alveolar proteinosis, pulmonarybrosis, exacerbated pulmonary brosis, sarcoidosis, ILD with a granulomatous component, hilar or mediastinal lymphadenopathy, pulmonary edema, ARDS, alveolar hemorrhage, angioedema, deterioration of asthma, chronic cough, pleural effusion including chylothorax, pulmonary embolism, emphysema, disordered breathing during sleep, hiccup, and such systemic syndromes as lupus, drug rash with eosinophilia and systemic symptoms, ANCA-related vasculitis, eosinophilic granulomatosis and polyangiitis, interstitial pneumonia with autoimmune features, myositis or polymyositis, the multiple organ dysfunction syndrome, or cardiomyopathy can all be triggered or caused by drugs [3, 4]. Consideration of the drug etiology can be rewarding in terms of reversal of all signs and symptoms with drug removal.

Eye Catchers

The reader is invited to visit the appropriate section of “eye-­ catching” images in pneumotox, where drug-induced and iatrogenic conditions may be so distinctive as to enable almost instant diagnosis [3, 4].

Conclusion

Drug-induced and iatrogenic respiratory problems are manifold and can be immediately life-threatening or fatal. Many are rare if not exceptional. Prevention rests on educating our-

selves and our colleagues and pupils in all specialties about the respiratory reactions that may occur with the drugs they prescribe, identifying risk factors, a high index of suspicion, examining any sign or symptom or constellation thereof for possible drug-relatedness using pneumotox and the literature [3, 4], avoidance of hazardous combination treatments, prompt identi cation of the causal agent and its removal, reliable measures to avoid inadvertent rechallenge with the culprit drug, and publication of cases. It is worth mentioning that household substances and chemicals can also cause eminently preventable acute lung or respiratory injury [3, 4]. For all causes and patterns of injury, Pneumotox can be accessed at any time through the appropriate website or App.

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